Pathogenesis of periodontal diseases : biological concepts for clinicians

This book aims to provide clinicians with a refined understanding of the biology that underlies periodontal diseases, thereby offering a sound basis for improved clinical decision making with regard to prevention strategies, diagnosis, and therapy. All significant aspects of periodontal pathogenesis are covered, including the roles played by the oral microbiome and biofilms, bacterial virulence factors, cells of the immune system, matrix metalloproteinases, proinflammatory and osteolytic cytokines, genetic factors, and antimicrobial peptides. Periodontal diseases are among the most common infectious diseases in humans, and the primary cause of tooth loss in adults. The functional and esthetic problems associated with these diseases compromise quality of life, and their treatment imposes large financial burdens on national health systems and private patients. Up-to-date knowledge of periodontal pathogenesis is therefore essential for the contemporary clinician. This book, written by experts from Europe and the Americas, delivers such knowledge in an accessible, clinician-friendly way. Contents 5 1: Periodontal Pathogenesis: Definitions and Historical Perspectives 6 1.1 Introduction: Realizations from an Epidemiological Perspective 6 1.2 Definition of Periodontal Disease from a Historical Perspective 6 1.3 The Eras of “Pitius” and “Calculus” 7 1.4 The Era of “Periodontosis” and “Pyorrhea Alveolaris” 7 1.5 The Eras of Histopathology and Microbial Causation 7 1.6 The Era of “Nonspecific Plaque” Hypothesis and Experimental Gingivitis 8 1.7 The Era of “Specific Plaque” Hypothesis and Periodontal Pathogenesis 8 1.8 Periodontal Pathogenesis Based on Description of Histopathological Features 9 1.9 Current Paradigm of Periodontal Pathogenesis 10 1.10 Pending Clinical Questions in the Era Systems Biology 10 References 11 2: Diversity of Oral Biofilms in Periodontal Health and Disease 13 2.1 The Oral Real Estate 13 2.2 Bacterial Diversity in Health 13 2.3 Bacterial Diversity in Periodontal Disease: Historical Perspective 18 2.4 Specific Microorganisms Associated with Periodontal Health and Disease 19 References 22 3: Subgingival Biofilms as Etiological Factors of Periodontal Disease 25 3.1 Definition of Subgingival Plaque as a Biofilm 25 3.2 Oral Biofilms: Microenvironment and Etiological Role in Oral Disease 26 3.2.1 Subgingival Biofilms and Their Association with Periodontitis 26 3.2.2 Composition and Structure of Subgingival Biofilms: General Concepts 27 3.2.3 Subgingival Biofilm Composition as Revealed by Metagenomics 28 3.3 In Vitro Modeling of Subgingival Biofilms 29 References 31 4: Bacterial Virulence Factors that Contribute to Periodontal Pathogenesis 34 4.1 Overview 34 4.2 Pathogenesis of Periodontal Disease 34 4.3 Periodontal Bacteria and Their Virulence Factors 36 4.4 Transmission Pattern and Colonization 40 4.5 Colonization and Infection 41 4.6 The Role of Aggregatibacter Actinomycetemcomitans 42 4.7 The Role of Porphyromonas Gingivalis 45 4.8 Concluding Remarks 46 References 47 5: Active Matrix Metalloproteinase-8: Contributor to Periodontitis and a Missing Link Between Genetics, Dentistry, and Medicine 53 5.1 Introduction 53 5.2 GCF Monitoring of Periodontitis by aMMP-8 54 5.3 Saliva and Mouthrinse Monitoring of Periodontitis by aMMP-8 55 5.4 Chairside Monitoring of Periodontitis by aMMP-8 56 References 58 6: Inflammatory Pathways of Bone Resorption in Periodontitis 60 6.1 Introduction 60 6.2 Generalities of Inflammation in Periodontitis Pathogenesis 60 6.2.1 From Health to Inflammatory Immune Response: How Homeostasis Evolves to Disease 61 6.2.2 The Parallels Between Acute Inflammation and Innate Immune Response 64 6.2.3 Osteoimmunology and the Molecular Connection 65 6.2.4 Chronic Inflammation and Adaptive Immune Response in Periodontitis 67 6.2.5 Adaptive Immune Responses May be Also Protective: A Role for Regulatory T Cells (Tregs) 69 6.3 Risk Determinants to Alveolar Bone Resorption in Periodontitis 71 6.3.1 Acquired Risk Factors 72 6.3.1.1 Tobacco 72 6.3.1.2 Immune Deficiencies 73 6.3.1.3 Metabolic Diseases 73 6.3.2 Innate Risk Determinants 75 6.4 Future Perspectives for the Treatment of Periodontitis: From the Bench to the Dental Chair 76 References 81 7: Genetic Influences on the Periodontal Microbial-Host Crosstalk 87 7.1 Introduction 87 7.2 Infectogenomics 87 7.3 Evidence for Genetic Variants Influencing the Response to Microbial Challenge 88 7.3.1 Microbial Recognition Genes 88 7.3.2 Genes Involved in Inflammatory Pathways 89 7.4 Genetic Effects on Microbial Colonization: Studies in Periodontal Disease 89 7.5 Challenges and Future Directions 93 References 93 8: Antimicrobial Peptides: Roles in Periodontal Health and Disease 96 8.1 Antimicrobial Peptides 96 8.2 Introduction 96 8.3 History of AMPs 97 8.4 AMPs Grouping 97 8.5 AMPs in the Periodontium 99 8.6 Double Edge Swards 100 8.7 The Homeostasis Between AMPs and the Microbiota 101 8.8 AMP Cell Membrane Interaction 102 8.9 AMPs and Endotoxins 103 References 104 9: Periodontal Pathogenesis: Conclusions and Future Directions 110 9.1 Future Directions in Diagnosis and Treatment of Periodontal Disease 112 References 112 Front Matter ....Pages i-v Periodontal Pathogenesis: Definitions and Historical Perspectives (Nagihan Bostanci, Georgios N. Belibasakis)....Pages 1-7 Diversity of Oral Biofilms in Periodontal Health and Disease (Purnima S. Kumar)....Pages 9-20 Subgingival Biofilms as Etiological Factors of Periodontal Disease (Thomas Thurnheer, Kai Bao, Georgios N. Belibasakis)....Pages 21-29 Bacterial Virulence Factors that Contribute to Periodontal Pathogenesis (Anders Johansson, Gunnar Dahlén)....Pages 31-49 Active Matrix Metalloproteinase-8: Contributor to Periodontitis and a Missing Link Between Genetics, Dentistry, and Medicine (Timo Sorsa, Anna Maria Heikkinen, Jussi Leppilahti, Taina Tervahartiala, Solomon Nwhator, Nilminie Rathnayake et al.)....Pages 51-57 Inflammatory Pathways of Bone Resorption in Periodontitis (Franco Cavalla, Claudia C. Biguetti, Thiago P. Garlet, Ana Paula F. Trombone, Gustavo P. Garlet)....Pages 59-85 Genetic Influences on the Periodontal Microbial-Host Crosstalk (Luigi Nibali)....Pages 87-95 Antimicrobial Peptides: Roles in Periodontal Health and Disease (Daniel Jönsson)....Pages 97-110 Periodontal Pathogenesis: Conclusions and Future Directions (Georgios N. Belibasakis, Nagihan Bostanci)....Pages 111-114