Causal theory of periodontal disease

歯周病はプラーク細菌によって発症し、徹底したプラークコントロールによりある程度改善する可能性のある病気です。
しかし特定のグラム陰性菌とスピロヘータが原因となって進行する歯周炎は激増している。歯周病の感染論を、病原菌と宿主の抵抗力との関係で論じるだけにとどまらず、歯周病原菌が全身の健康を害する事についての知見を含めて上記の文献には紹介されています。

invader bacteria It has even been called

Invader Bacteria in Periodontal Pockets
Periodontopathogenic bacteria invade as invaders, communicating with each other and settling in periodontal localities as a group.

Adapted from the above paper Health Promotion from Periodontal Disease Prevention

A. Causes of periodontal disease
How far have pathogenic bacteria been identified
Potential pathogenic threats to health

TOC

Periodontal disease is a bacterial infection.

Periodontal disease is an obvious infection, mainly caused by anaerobic bacteria.
By understanding the risk factors that determine the onset and progression of disease, we can consider everything from treatment to prevention.

Risk factors for periodontal disease

  • population ageing (aging)
    • Compared to young cells, aged gingival fibroblasts produce the following inflammatory factors upon periodontal pathogenic endotoxin stimulation.
      • prostaglandin E2
      • Interleukin-41β Osteoclast activator
      • Interleukin-6 Factor causing bone resorption
  • smoking
    • 1 Decrease neutrophil function
    • 2 Injury to periodontal tissue microcirculation
    • 3 Decrease secretion of salivary fractionated IgA
    • 4 Injury to gingival fibroblasts
  • stress
    • Decreases NK cell activity
  • diabetes mellitus
    • Decreased infection defense
  • osteoporosis
    • Bone Metabolic Disorders

2 Periodontal pathogenic bacteria

Toxins produced by periodontal bacteria
There are two types of toxins produced by bacteria.

  1. Exotoxin — toxin secreted outside the bacteria
  2. endotoxin — a component of the outer membrane of Gram-negative bacteria

Exotoxins are composed of proteins that the fungus produces on its body, most of which are easily destroyed by heat. They are highly toxic on a per-unit basis (acting in μ/quantity).
Endotoxins consist of cellular components of Gram-negative bacteria.

In pathological periodontal pockets, “Porphyromonas gingivalis and Treponema denticola coexist.
In deeper pockets, Bcteroides forsythus is added. The three species are most virulent in mixed infections.”
All periodontopathogenic Gram-negative rods possess an endotoxin composed of lipopolysaccharide (LPS), a lipopolysaccharide that is responsible for the induction of inflammation and the development of the inflammatory process.
The endotoxin induces inflammation and alveolar bone resorption.

Physiological activity of endotoxins

  1. Exothermic.
  2. Vasodilatory effects.
  3. Coagulates blood.
  4. Involves local and systemic bleeding and necrosis.
  5. It leads to the production of antibodies involved in allergies and autoimmune diseases.
  6. Promotes budding of inflammatory cytokines from cells.
  7. Activates complement and causes inflammation.
  8. Causes bone resorption.

Main causative organisms of each type of periodontal disease

  • adult-onset periodontitis
    • Porphyromonas gingivalis
    • Accinobacillus actinomycetemcomitans
    • Prevotella intermedia
    • Bcteroides forsythus
    • Eikenella corrodens
    • Treponema denticola
  • active site
    • Porphyromonas gingivalis
    • Campylobacter rectus
    • Prevotella intermedia
    • Bcteroides forsythus
  • Refractory sites (recurrent sites)
    • Porphyromonas gingivalis
    • Bcteroides forsythus
    • Fusobacterium nucleatum
  • juvenile periodontitis
    • Accinobacillus actinomycetemcomitans
    • Capnocytophaga species
  • acute necrotizing ulcerative gingivitis
    • Prevotella intermedia
    • Treponema denticola
  • pregnancy gingivitis
    • Prevotella intermedia
  • adolescent gingivitis
    • Prevotella intermedia

3. periodontal pathogens that are detrimental to systemic health

Endotoxins produced by periodontal pathogens and pathogens enter the bloodstream through the gingival marginal epithelium.

  1. Effects on the cardiovascular system
    • Bacterial endocarditis Bacteria entering the bloodstream in healthy individuals are quickly eradicated by various defense mechanisms, but if the number of bacteria entering the bloodstream is large or if the patient loses resistance, sepsis may occur.
    • Sepsis due to oral Streptococcus spp. should be noted in patients with cancer, diabetes, and immunocompromised patients, as well as in those with valvular disease and in the elderly.
    • Accinobacillus actinomycetemcomitans has an exotoxin, leukotoxin, which is not easily sterilized when it enters the bloodstream and adheres to the valve leaflets, causing endocarditis.
    • When periodontal disease is present, local periodontal bacteria enter the bloodstream during tooth brushing and even during chewing (eating), causing bacteremia.
  2. Impact on respiratory infections
    • Bacteria in the oral cavity may be inhaled unknowingly and cause pneumonia.
    • Aspiration pneumonia is also caused by the inability to ingest food properly.
    • The pathogen responsible for senile pneumonia is a periodontal pathogen.
  3. Diabetes mellitus, exacerbating factors for osteoporosis
  4. Pregnancy Troubles
  5. Periodontal disease as a primary lesion for focal infection

Reference download literature [PDF]Health Promotion from Periodontal Disease Prevention

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