Pathogenesis of Inflammatory and Dystrophic Processes
The development of the pathology represents a sequential cascade of reactions in which microbial aggression is closely intertwined with the host immune response. The process does not occur spontaneously, but rather follows a series of regular stages, each of which exacerbates the damage to the tooth-supporting apparatus.
- Biofilm formation. The primary initiating event is always the formation of dental plaque. Microorganisms colonize the tooth surface, creating a resilient community.
- Initiation of inflammation. The presence of bacterial mass triggers a response in adjacent tissues, which clinically manifests as gingivitis—inflammation of the gingiva without involvement of the bone structures.
- Destructive phase. As the process progresses, the breakdown of collagen fibers is triggered. A crucial role at this stage is played not only by the bacteria themselves, but also by immunopathological reactions. A hyper-reactive immune response leads to resorption of the alveolar process bone (tooth socket).
- Terminal stage. The outcome of the uncontrolled inflammatory-dystrophic process is the loss of the periodontal ligament apparatus and tooth exfoliation.
Microbiology of Periodontitis: Acute and Chronic Forms
Periodontitis is characterized by deep lesions of the periodontal complex. It is critical to differentiate between acute and chronic forms of the disease, as their microbial profiles have fundamental differences. Filamentous and flagellated microorganisms traditionally predominate in the subgingival zone during periodontitis.
Acute periodontitis is associated with highly aggressive microflora capable of rapid tissue damage. This group includes:
- Aggregatibacter actinomycetemcomitans
- Eikenella corrodens
- Capnocytophaga sputigena
- Prevotella intermedia
Chronic periodontitis is distinguished by a different spectrum of dominant pathogens. Key pathogens here include Porphyromonas gingivalis, Tannerella forsythia, and Prevotella intermedia.
In addition to the main pathogens, an abundant concomitant flora is always present in the lesion focus. It includes spirochetes, peptostreptococci, various bacteroides, staphylococci, streptococci, and even enterobacteria. Such microbial diversity complicates the course of the disease and requires a comprehensive approach to sanitization.
Microflora in Gingivitis and Pericoronitis
Ggingivitis and pericoronitis represent pathologies predominantly limited to gingival tissue involvement (without alveolar bone destruction). The microbial profile in these conditions also has specific features.
In foci of gingival inflammation, a large number of Gram-negative and filamentous bacteria are detected. Typical flora includes:
- Spirochetes and actinomycetes
- Campylobacter species
- Veillonella and peptostreptococci
Among the specific species playing a leading role in maintaining soft tissue inflammation are Prevotella intermedia and Fusobacterium nucleatum. These microorganisms actively colonize the gingival sulcus, maintaining a local infectious process that, in the absence of intervention, can progress to periodontitis.