Bacterial Spectrum in Relation to Periodontal Diseases

This document provides a summary of the microbes that play a major role in the causation of various periodontal and peri-implant diseases.

1. BACTERIAL SPECTRUM
IN RELATION TO
PERIODONTAL DISEASES
Dr Akriti

2. CONTENT
●STATES OF PERIODONTIUM
●ETIOLOGICAL FACTORS
●PERIODONTAL PATHOGENS
●BACTERIAL SPECTRUM IN PERIODONTAL
DISEASES
●ADVANCES IN PERIODONTAL
MICROBIOLOGY

4. STATES OF PERIODONTIUM
HEALTHY
GINGIVITIS
PERIODONTITIS

5. ETIOLOGICAL FACTORS

7. PERIODONTAL PATHOGENS
Criteria for the Identification of PERIODONTOPATHOGENS:
Koch Postulates (1876), stipulate that the causative agent
must do the following:
●Be routinely isolated from diseased individuals.
●Be grown in pure culture in the laboratory.
●Produce a similar disease when inoculated into
susceptible laboratory animals.
●Be recovered from lesions in a diseased laboratory
animal.

8. Sigmund Socransky proposed a set of criteria by which
periodontal microorganisms may be judged to be
periodontal pathogens:
●Be associated with disease
●Be eliminated or decreased in sites that show
resolution of disease
●Induce host response
●Be capable of causing disease in experimental
animals
●Produce demonstrable virulence factors

9. MICROBIOLOGIC SPECIFICITY OF
PERIODONTAL DISEASES

10. ARTICLE

11. ●Streptococcus spp.
●Actinomyces spp.
●Eubacterium spp.
●Capnocytophaga spp.
●Fusobacterium spp.
●Prevotella spp.
●Haemophilus spp.
●Eikenella spp.
●Porphyromonas spp.
●Treponema spp.
●Aggregatebacter spp.
●Campylobacter spp.
●Tannerela spp.
●Spirochetes

12. STREPTOCOCCUS
●Gram +ve, spherical cocci
●Viridans streptococci are
commensals in the mouth and
oropharynx.
●The species include S.salivarius,
S.sanguis, S.mutans, S.mitis,
S.milleri.
●S.mutans, S.sanguis cause dental
caries

13. ACTINOMYCES
●Gram +ve, grow in mycelial
forms, facultative anaerobes
●A.odontolyticus, A.viscosus,
A.naeslundii are commensals
of mouth
●Dental plaque and caries.

14. EUBACTERIUM SPECIES
●Gram positive, strictly
anaerobic, small pleomorphic
rods
●Possible periodontal
pathogen due to increased
level in disease sites
●Elicit elevated antibody
responses in subjects with
destructive periodontitis
●Eubacterium nodatum

15. CAPNOCYTOPHAGA
●Gram -ve, fusiform or filamentous,
fermentous, facultative anaerobes
●On agar surfaces, produce a
yellow-orange pigment
●Severe periodontal disease in
juveniles
●C.ochracea, C.gingivalis,
C.sputigena are members of normal
oral flora.

16. FUSOBACTERIUM NUCLEATUM
●Gram -ve, spindle (cigar) shaped
●Part of the subgingival microbiota
●Associated with almost all types
of periodontal diseases
●Mechanism:
○Increased secretion of IL-8
○Induces apoptotic cell death in
mononuclear &
polymorphonuclear cells

17. PREVOTELLA INTERMEDIA
●Gram -ve, obligate anaerobic
●Periodontal infections,
including gingivitis & often
found in acute necrotising
ulcerative gingivitis and
dental abscesses

18. HAEMOPHILUS
●Gram -ve rod or coccobacillus
●In sputum, clusters of coccobacillary
forms are seen
●Difficult to stain, often capsulated
(demonstrated by India ink wet films,
Quellung reaction)
●H.parainfluenzae, H.aphrophilus occur
as commensals in mouth.

19. EIKENELLA CORRODENS
●Gram -ve, small rod with
blunt ends
●Found more frequently in
sites of periodontal
destruction as compared
with healthy sites & higher
levels in active sites

20. PORPHYROMONAS GINGIVALIS
●Gram negative, anaerobic, coccal to short rod morphology
●Known to invade host tissue cells in aggressive forms
of Periodontitis

21. TREPONEMA DENTICOLA
●Gram +ve, obligatory anaerobic
●Accounts for 50% of the total bacteria
present in a periodontal lesion
●It increases to large number in adult
periodontitis
●almost undetectable in oral health

22. AGGREGATEBACTER
ACTINOMYCETEMCOMITANS
●Gram -ve, round ended rod
●Forms small convex colonies with a
star shaped center on blood agar
●Known to invade host tissue
cells, significant in aggressive
forms of Periodontitis
●SEROTYPES: a,b,c,d,e,f
●Serotype b – LAP
Serotype a – Chronic
Periodontitis

23. CAMPYLOBACTER RECTUS
●Gram negative, anaerobic
vibrio
●Small convex, “dry spreading”
or “corroding” colonies on
blood agar plates
●Higher number in diseased
site & in sites exhibiting
periodontal destruction

24. TANNERELA FORSYTHIA
●Gram negative, anaerobic,
highly pleomorphic rod
●Requiring 7-14 days for
colonies to form
●Detected more frequently in
active periodontal lesions
●Cause proteolytic activity &
induces apoptotic cell death

25. SPIROCHETES
●Gram negative, anaerobic,
helical shaped
●Common in periodontal
pockets
●Etiologic agent of ANUG
●Mechanism:
○Travels through viscous
environment (high motility)
○Degrades collagen & dentin
○Destroys IgA, IgM, IgG

26. BACTERIAL SPECTRUM IN RELATION TO
PERIODONTAL DISEASES
As health progresses to
periodontitis:
•From gram positive to gram negative
•From cocci to rods
•From non motile to motile organism
•From facultative anaerobes to obligate
anaerobes
•From fermenting to proteolytic species

27. PERIODONTAL
DISEASES
●Gingivitis
●Pregnancy Gingivitis
●Chronic Periodontitis
●Localized Aggressive
Periodontitis
●Generalized Aggressive
Periodontitis
●Necrotizing Periodontal
Diseases
●Abscesses of the
Periodontium
●Periimplantitis

28. GINGIVITIS
Initial microbiota:
•Gram +ve rods & cocci
•Gram-ve cocci
Inflammatory changes
•Gram -ve rods & filaments
•Spirochetal & motile microorganism
Gram +ve species: S.sanguis, S.mitis, S.intermedius, S.oralis,
S.anginosus, A.oris, A.naeslundii, E.nodatum, P.micra.
Gram -ve species: Capnocytophaga spp., Fusobacterium spp.,
Prevotella spp., Haemophilus spp., E.corrodens, V.parvula.

29. PREGNANCY GINGIVITIS
●Acute inflammation of gingiva
at the time of pregnancy
●Accompanied by increase
level of steroid hormones
in the crevicular fluids
●Large increase in levels of
P.intermedia & C rectus
●These microbes use steroid
as growth factors

30. CHRONIC PERIODONTITIS
Anaerobic (90%), Gram -ve (75%) bacterial species.



Bacterial species include:
•P. gingivalis ,
•T. forsythia,
•P. intermedia,
•C. rectus,
•E. corrodens,
•F. nucleatum,
•A. actinomycetamcomitans,
•E. nodatum,
•T. denticola

31. ●Young age & rapid onset
●Dominant microbes
○A.Actinomycetemcomitans
○P.gingivalis,
○E.corrodens,
○P.intermedia,
○Capnocytophaga spp.,
○T.forsythia
○T.denticola
○E.nodatum,
○Campylobacter gracilis,
○Campylobacter showae.
●Severe gingivitis, deep pockets, high tendency for bleeding
on probing.

AGGRESSIVE PERIODONTITIS

32. ●Acute inflammation of periodontal
tissue characterized by necrosis of
marginal gingival tissue &
interdental papillae.
●Often associated with stress or HIV.
●May be accompanied by malodor, pain
and possibly systemic symptoms.
●Microorganisms include:
○P.intermedia
○F.nucleatum
○Spirochetes
NECROTIZING PERIODONTAL DISEASES

35. ●Acute destructive process in
the periodontium
●Localised collection of pus
● MICROFLORA:
○F. nucleatum,
○P. intermedia,
○P. gingivalis,
○P. micra,
○T. forsythia
ABSCESSES OF THE PERIODONTIUM

36. PERI-IMPLANTITIS
●A.actinomycetemcomitans,
●P.gingivalis,
●T.forsythia,
●C.rectus,
●F.Nucleatum,
●P.intermedia,
●T.denticola,
●Capnocytophaga
●Psuedomonas aeruginosa,
●Enterobacter spp.,
●Staphylococcus aureus.
●S.mutans

38. ADVANCES IN PERIODONTAL MICROBIOLOGY
●DNA-based methodologies
●Increase in the number of samples
●Detect microorganisms that couldn't be cultivated
so far
●Greater awareness of the role of the host response
in periodontal disease
●Recognition of the beneficial activity of several
groups of commensal species