Periodontal disease is of inflammatory origin and affects the dental support tissues. The initial phase is characterized by the accumulation of biofilm, which is a predisposing factor for several oral pathologies. The combination of extrinsic factors such as lack of hygiene, smoking and diet, and intrinsic factors such as genetics, and major changes in the immune response associated with immune escape mechanisms of biofilm constituents are crucial to the development and progression of the disease, which when untreated entails local irreversible consequences that can lead to systemic changes. In this brief review, we describe general aspects of periodontal disease, its risk factors and ways of preventing the disease. In particular, we discuss some of the mechanisms of immune response to periodontal pathogens, as well as the escape mechanisms of these microorganisms.
Kholy, K.E., Genco, R.J. and Van Dyke, T.E. (2015) Oral Infections and Cardiovascular Disease. Trends in Endocrinology & Metabolism, 26, 315-321. https://doi.org/10.1016/j.tem.2015.03.001
National Center for Health Statistics. Health, the United States, 2014: With Special Feature on Adults Aged 55-64. Hyattsville, MD. 2015.
Bartold, P.M. and Van Dyke, T.E. (2013) Periodontitis: A Host-Mediated Disruption of Microbial Homeostasis. Unlearning Learned Concepts. Periodontology 2000, 62, 203-217.
Gemell, E., Yamazak, K. and Gregory, J. (2007) The Role of T Cells in Periodontal Disease: Homeostasis and Autoimmunity. Periodontology 2000, 43, 14-40. https://doi.org/10.1111/j.1600-0757.2006.00173.x
Azuma, M. (2006) Fundamental Mechanisms of Host Immune Responses to Infection. Journal of Periodontal Research, 41, 361-373. https://doi.org/10.1111/j.1600-0765.2006.00896.x
Teng, Y.T., et al. (2000) Functional Human T-Cell Immunity and Osteoprotegerin Ligand Control Alveolar Bone Destruction in Periodontal Infection. The Journal of Clinical Investigation, 106, 59-67. https://doi.org/10.1172/JCI10763
Kononen, E. and Muller, H.P. (2014) Microbiology of Aggressive Periodontitis. Periodontology 2000, 65, 46-78. https://doi.org/10.1111/prd.12016
Kozarov, E.V., Dorn, B.R., Shelburne, C.E., et al. (2005) Human Atherosclerotic Plaque Contains Viable Invasive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Arteriosclerosis, Thrombosis, and Vascular Biology, 25, 17-18. https://doi.org/10.1161/01.ATV.0000155018.67835.1a
Venkataramani, A., Santo-Domingo, N.E. and Main, D.M. (1994) Actinobacillus Actinomycetemcomitans Pneumonia with Possible Septic Embolization. Chest, 105, 645-646.
Dewhirst, F.E., Chen, T., Izard, J., et al. (2010) The Human oral Microbiome. Journal of Bacteriology, 192, 5002-5017.
Aas, J.A., et al. (2005) Defining the Normal Bacterial Flora of the Oral Cavity. Journal of Clinical Microbiology, 43, 5721-5732. https://doi.org/10.1128/JCM.43.11.5721-5732.2005
Yucel-Lindberg, T. and Bage, T. (2013) Inflammatory Mediators in the Pathogenesis of Periodontitis. Expert Reviews in Molecular Medicine, 15, 1-22.
D’Aiuto, F., et al. (2017) Evidence Summary: The Relationship between Oral Diseases and Diabetes. British Dental Journal, 222, 944-948.
Alexandridi, F., Tsantila, S. and Pepelassi, E. (2017) Smoking Cessation and Response to Periodontal Treatment. Australian Dental Journal. https://doi.org/10.1111/adj.12568
American Academy of Periodontology (2000) Parameter on Chronic Periodontitis with Slight to Moderate Loss of Periodontal Support. Periodontology 2000, 71, 853-855.
Armitage, G.C. (1999) Development of a Classification System for Periodontal Diseases and Conditions. Annals of Periodontology, 4, 1-6. https://doi.org/10.1902/annals.1999.4.1.1
Bergstrom, J. (2014) Smoking Rate and Periodontal Disease Prevalence: 40-Year Trends in Sweden 1970-2010. Journal of Clinical Periodontology, 41, 952-957. https://doi.org/10.1111/jcpe.12293
Sanz, M., D’Aiuto, F., Deanfield, J. and Fernandez-Avilés, F. (2010) European Workshop in Periodontal Health and Cardiovascular Disease-Scientific Evidence on the Association between Periodontal and Cardiovascular Diseases: A Review of the Literature. European Heart Journal Supplements, 12, 3-12. https://doi.org/10.1093/eurheartj/suq003
Underner, M., Maes, I., Urban, T. and Meurice, J.C. (2009) Effects of Smoking on Periodontal Disease. Revue des Maladies Respiratoires, 26, 1057-1073. https://doi.org/10.1016/S0761-8425(09)73533-8
Albandar, J.M., Streckfus, C.F., Adesanya, M.R. and Winn, D.M. (2000) Cigar, Pipe, and cigarette Smoking as Risk Factors for Periodontal Disease and tooth Loss. Journal of Periodontology, 71, 1874-1881. https://doi.org/10.1902/jop.2000.71.12.1874
Reners, M. and Brecx, M. (2007) Stress and Periodontal Disease. International Journal of Dental Hygiene, 5, 199-204. https://doi.org/10.1111/j.1601-5037.2007.00267.x
Nociti, F.H., et al. (2001) Histometric Evaluation of the Effect of Nicotine Administration on Periodontal Breakdown: An In Vivo Study. Journal of Periodontal Research, 36, 361-366. https://doi.org/10.1034/j.1600-0765.2001.360603.x
Oliveira, C., Watt, R. and Hamer, M. (2010) Toothbrushing, Inflammation, and Risk of Cardiovascular Disease: Results from Scottish Health Survey. BMJ, 340, 1-6. https://doi.org/10.1136/bmj.c2451
Albandar, J.M. (2002) Global Risk Factors and Risk Indicators for Periodontal Diseases. Periodontology, 29, 177-206. https://doi.org/10.1034/j.1600-0757.2002.290109.x
Axelsson, P., Lindhe, J. and Nyström, B. (1991) On the Prevention of Caries and Periodontal Disease. Results of a 15-Year Longitudinal Study in Adults. Journal of Clinical Periodontology, 18, 182-189. https://doi.org/10.1111/j.1600-051X.1991.tb01131.x
Casanova, L., Hughes, F.J. and Preshaw, P.M. (2014) Diabetes and Periodontal Disease: A Two-Way Relationship. British Dental Journal, 217, 433-437. https://doi.org/10.1038/sj.bdj.2014.907
Preshaw, P.M. and Bissett, S.M. (2013) Periodontitis: Oral Complication of Diabetes. Endocrinology and Metabolism Clinics of North America, 42, 849-867. https://doi.org/10.1016/j.ecl.2013.05.012
Grossi, S.G., et al. (1994) Assessment of Risk for Periodontal Disease. I. Risk Indicators for Attachment Loss. Journal of Periodontology, 65, 260-267. https://doi.org/10.1902/jop.1994.65.3.260
Patel, M.H., Kumar, J.V. and Moss, M.E. (2013) Diabetes and Tooth Loss: An Analysis of Data from the National Health and Nutrition Examination Survey, 2003-2004. The Journal of the American Dental Association, 144, 478-485. https://doi.org/10.14219/jada.archive.2013.0149
Chapple, I.L. and Genco, R. (2013) Working Group 2 of the Joint EFP/AAP Workshop. Diabetes and Periodontal Diseases: Consensus Report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of Periodontology, 84, 106-112. https://doi.org/10.1902/jop.2013.1340011
Güncü, G.N., Tüzüm, T.F. and Caglayan, F. (2005) Effects of Endogenous Sex Hormones on the Periodontium—Review of Literature. Australian Dental Journal, 50, 138-145. https://doi.org/10.1111/j.1834-7819.2005.tb00352.x
Scully, C. (2003) Drug Effects on Salivary Glands: Dry Mouth. Oral Diseases, 9, 165-176. https://doi.org/10.1034/j.1601-0825.2003.03967.x
Rai, B., Kaur, J., Anand, S.C. and Jacobs, R. (2011) Salivary Stress Markers, Stress, and Periodontitis: A Pilot Study. Journal of Periodontology, 82, 287-292. https://doi.org/10.1902/jop.2010.100319
Padmini, C. and Bai, K.Y. (2014) Oral and Dental Considerations in Pediatric Leukemic Patient. ISRN Hematology, 2014, Article ID: 895721.
Barbería, E., Hernandez, C., Miralles, V. and Maroto, M. (2008) Paediatric Patients Receiving Oncology Therapy: Review of the Literature and Oral Management Guidelines. European Journal of Paediatric Dentistry, 9, 188-194.
Takeichi, O., et al. (2000) Cytokine Profiles of T-Lymphocytes from Gingival Tissues with Pathological Pocketing. Journal of Dental Research, 79, 1548-1555. https://doi.org/10.1177/00220345000790080401
Amano, A. (2010) Bacterial Adhesins to Host Components in Periodontitis. Periodontology, 52, 12-37. https://doi.org/10.1111/j.1600-0757.2009.00307.x
Tonetti, M.S., et al. (1994) Localized Expression of mRNA for Phagocyte-Specific Chemotactic Cytokines in Human Periodontal Infections. Infection and Immunity, 62, 4005-4014.
Rossi, D. and Zlotnik, A. (2000) The Biology of Chemokines and Their Receptors. Annual Review of Immunology, 18, 217-242. https://doi.org/10.1146/annurev.immunol.18.1.217
Zlotnik, A. and Yoshie, O. (2000) Chemokines: A New Classification System and Their Role in Immunity. Immunity, 12, 121-127. https://doi.org/10.1016/S1074-7613(00)80165-X
Ridiandries, A., Tan, J.T. and Bursill, C.A. (2016) The Role of CC-Chemokines in the Regulation of Angiogenesis. International Journal of Molecular Sciences, 17, 2-16. https://doi.org/10.3390/ijms17111856
Fogarty, C.E. and Bergmann, A. (2015) The Sound of Silence: Signaling by Apoptotic Cells. Current Topics in Developmental Biology, 114, 241-265. https://doi.org/10.1016/bs.ctdb.2015.07.013
Mayadas, T.N., Cullere, X. and Lowell, C.A. (2014) The Multifaceted Functions of Neutrophils. Annual Review of Pathology, 9, 181-218. https://doi.org/10.1146/annurev-pathol-020712-164023
Gomes, F.I., et al. (2016) Inflammatory Cytokines Interleukin-1β and Tumour Necrosis Factor-α-Novel Biomarkers for the Detection of Periodontal Diseases: A Literature Review. Journal of Oral & Maxillofacial Research, 7,
Graves, D. (2008) Cytokines That Promote Periodontal Tissue Destruction. Journal of Periodontology, 79, 1585-1591. https://doi.org/10.1902/jop.2008.080183
Graves, D.T., Oates, T. and Garlet, G.P. (2011) Review of Osteoimmunology and the Host Response in Endodontic and Periodontal Lesions. Journal of Oral Microbiology, 17, https://doi.org/10.3402/jom.v3i0.5304
Chen, B., et al. (2014) RANKL Expression in Periodontal Disease: Where Does RANKL Come from? BioMed Research International, 1-7. https://doi.org/10.1155/2014/731039
Song, L., Dong, G., Guo, L. and Graves, D.T. (2017) The Function of Dendritic Cells in Modulating the Host Response. Molecular Oral Microbiology. https://doi.org/10.1111/omi.12195
Cifcibasi, E., et al. (2015) The Role of Activated Cytotoxic T Cells in Etiopathogenesis of Periodontal Disease: Does It Harm or Does It Heal? Scientific Reports, 5.
Raphael, I., Nalawade, S., Eagar, T.N. and Forsthuber, T.G. (2015) T Cell Subsets and Their Signature Cytokines in Autoimmune and Inflammatory Diseases. Cytokine, 74, 5-17. https://doi.org/10.1016/j.cyto.2014.09.011
Dutzan, N., et al. (2009) Levels of Interferon-Gamma and Transcription Factor T-Bet in Progressive Periodontal Lesions in Patients with Chronic Periodontitis. Journal of Periodontology, 80, 290-296. https://doi.org/10.1902/jop.2009.080287
Jotwani, R., et al. (2001) Mature Dendritic Cells Infiltrate the T-Cell Rich Region of Oral Mucosa in Chronic Periodontitis: In Situ, In Vivo and In Vitro Studies. The Journal of Immunology, 167, 4693-700. https://doi.org/10.4049/jimmunol.167.8.4693
Yoshie, H., et al. (1985) Periodontal Bone Loss and Immune Characteristics of Congenitally Athymic and Thymus Cell-Reconstituted Athymic Rats. Infection and Immunity, 50, 403-408.
Campbell, L., Millhouse, E., Malcolm, J. and Culshaw, S. (2016) T Cells, Teeth and Tissue Destruction What Do T Cells Do in Periodontal Disease? Molecular Oral Microbiology, 31, 445-456. https://doi.org/10.1111/omi.12144
Appay, V., van Lier, R.A., Sallusto, F. and Roederer, M. (2008) Phenotype and Function of Human T Lymphocyte Subsets: Consensus and Issues. Cytometry A, 73, 975-983. https://doi.org/10.1002/cyto.a.20643
Sallusto, F. and Lanzavecchia, A. (2009) Human Th17 Cells in Infection and Autoimmunity. Microbes and Infection, 11, 620-624. https://doi.org/10.1016/j.micinf.2009.04.004
Gálvez, J. (2014) Role of Th17 Cells in the Pathogenesis of Human IBD. ISRN Inflammation, 1-14. https://doi.org/10.1155/2014/928461
Vernal, R., Dutzan, N., Chaparro, A., Puente, J., Antonieta Valenzuela, M. and Gamonal, J. (2005) Levels of Interleukin-17 in Gingival Crevicular Fluid and in Supernatants of Cellular Cultures of Gingival Tissue from Patients with Chronic Periodontitis. Journal of Clinical Periodontology, 32, 383-389. https://doi.org/10.1111/j.1600-051X.2005.00684.x
Oda, T., Yoshie, H. and Yamazaki, K. (2003) Porphyromonas gingivalis Antigen Preferentially Stimulates T Cells to Express IL-17 but Not Receptor Activator of NF-κB Ligand In Vitro. Oral Microbiology and Immunology, 18, 30-36. https://doi.org/10.1034/j.1399-302X.2003.180105.x
Crotti, T., Smith, M.D., Hirsch, R., et al. (2003) Receptor Activator NF kappaB ligand (RANKL) and Osteoprotegerin (OPG) Protein Expression in Periodontitis. Journal of Periodontal Research, 38, 380-387. https://doi.org/10.1034/j.1600-0765.2003.00615.x
Togashi, Y. and Nishikawa, H. (2017) Regulatory T Cells: Molecular and Cellular Basis for Immunoregulation. Current Topics in Microbiology and Immunology. https://doi.org/10.1007/82_2017_58
Garlet, G.P., Sfeir, C.S. and Little, S.R. (2014) Restoring Host-Microbe Homeostasis via Selective Chemoattraction of Tregs. Journal of Dental Research, 93, 834-839. https://doi.org/10.1177/0022034514544300
Nakajima, T., et al. (2005) Regulatory T-Cells Infiltrate Periodontal Disease Tissues. Journal of Dental Research, 84, 639-643. https://doi.org/10.1177/154405910508400711
Cardoso, C.R., et al. (2008) Characterization of CD4 (+) CD25 (+) Natural Regulatory T Cells in the Inflammatory Infiltrate of Human Chronic Periodontitis. Journal of Leukocyte Biology, 84, 311-318. https://doi.org/10.1189/jlb.0108014
Ernst, C.W., et al. (2007) Diminished Forkhead Box P3/CD25 Double Positive T Regulatory Cells Are Associated with the Increased Nuclear Factor—κB Ligand (RANKL +) T Cells in the Bone Resorption Lesion of Periodontal Disease. Clinical & Experimental Immunology, 148, 271-280. https://doi.org/10.1111/j.1365-2249.2006.03318.x
Zijnge, V., et al. (2012) Subgingival Biofilm Structure. Frontiers of Oral Biology, 15, 1-16.
Zelkha, S.A., Freilich, R.W., Amar, S. (2010) Periodontal Innate Immune Mechanisms Relevant to Atherosclerosis and Obesity. Journal of Periodontology, 54, 207-221. https://doi.org/10.1111/j.1600-0757.2010.00358.x
Carvalho, R.P., et al. (2009) Relationship of Neutrophil Phagocytosis and Oxidative Burst with the Subgingival Microbiota of Generalized Aggressive Periodontitis. Oral Microbiology and Immunology, 24, 124-132. https://doi.org/10.1111/j.1399-302X.2008.00484.x
Marsh, P.D. and Zaura, E. (2017) Dental Biofilm: Ecological Interactions in Health and Disease. Journal of Clinical Periodontology, 18, 12-22. https://doi.org/10.1111/jcpe.12679
Baek, K.J., Ji, S., Kim, Y.C. and Choi, Y. (2015) Association of the Invasion Ability of Porphyromonas gingivalis with the Severity of Periodontitis. Virulence, 6, 274-281. https://doi.org/10.1080/21505594.2014.1000764
Bao, K., Belibasakis, G.N., Thurnheer, T., Aduse-Opoku, J., Curtis, M.A. and Bostanci, N. (2014) Role of Porphyromonas gingivalis Gingipains in Multi-Species Biofilm Formation. BMC Microbiology, 14, 258. https://doi.org/10.1186/s12866-014-0258-7
Kobayashi-Sakamoto, M., Isogai, E. and Hirose, K. (2003) Porphyromonas gingivalis Modulates the Production of Interleukin 8 and Monocyte Chemotactic Protein 1 in Human Vascular Endothelial Cells. Current Microbiology, 46, 109-114. https://doi.org/10.1007/s00284-002-3782-x
Slaney, J.M. and Curtis, M.A. (2008) Mechanisms of Evasion of Complement by Porphyromonas gingivalis. Frontiers in Bioscience, 13, 188-196. https://doi.org/10.2741/2669
Hajishengallis, G., Maekawa, T., Abe, T., Hajishengallis, E. and Lambris, J.D. (2015) Complement Involvement in Periodontitis: Molecular Mechanisms and Rational Therapeutic Approaches. Advances in Experimental Medicine and Biology, 865, 57-74. https://doi.org/10.1007/978-3-319-18603-0_4
Doke, M., Fukamachi, H., Morisaki, H., Arimoto, T., Kataoka, H. and Kuwata, H. (2017) Nucleases from Prevotella intermedia Can Degrade Neutrophil Extracellular Traps. Molecular Oral Microbiology, 32, 288-300. https://doi.org/10.1111/omi.12171
Heitz-Mayfield, L.J.A. and Lang, N.P. (2013) Surgical and Nonsurgical Periodontal Therapy. Learned and Unlearned Concepts. Journal of Periodontology, 62, 218-230. https://doi.org/10.1111/prd.12008
Braun, A., Jepsen, S. and Krause, F. (2007) Subjective Intensity of Pain during Ultrasonic Supragingival Calculus Removal. Journal of Clinical Periodontology, 34, 668-672. https://doi.org/10.1111/j.1600-051X.2007.01100.x
Tunkel, J., Heinecke, A. and Flemmig, T.F. (2002) A Systematic Review of Efficacy of Machine-Driven and Manual Subgingival Debridement in the Treatment of Chronic Periodontitis. Journal of Clinical Periodontology, 29, 72-81, Discussion 90-71. https://doi.org/10.1034/j.1600-051X.29.s3.4.x
Ribeiro, E. del P., Bittencourt, S., Sallum, E.A., Sallum, A.W., Nociti Jr, F.H. and Casati, M.Z. (2010) Non-Surgical Instrumentation Associated with Povidone-Iodine in the Treatment of Interproximal Furcation Involvements. Journal of Applied Oral Science, 18, 599-606. https://doi.org/10.1590/S1678-77572010000600011
Bonito, A.J., Lux, L. and Lohr, K.N. (2005) Impact of Local Adjuncts to Scaling and Root Planing in Periodontal Disease Therapy: A Systematic Review. Journal of Periodontology, 76, 1227-1236. https://doi.org/10.1902/jop.2005.76.8.1227
Serrano, C., Torres, N., Valdivieso, C., Castano, C., Barrera, M. and Cabrales, A. (2009) Antibiotic Resistance of Periodontal Pathogens Obtained from Frequent Antibiotic Users. Acta Odontológica Latinoamericana, 22, 99-104.
Sgolastra, F., Petrucci, A., Gatto, R., Marzo, G. and Monaco, A. (2013) Photodynamic Therapy in the Treatment of Chronic Periodontitis: A Systematic Review and Meta-Analysis. Lasers in Medical Science, 28, 669-682. https://doi.org/10.1007/s10103-011-1002-2
Bansal, R. and Jain, A. (2015) Current Overview on Dental Stem Cells Applications in Regenerative Dentistry. Journal of Natural Science, Biology, and Medicine, 6, 29-34. https://doi.org/10.4103/0976-9668.149074