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Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth

caused by specific microorganism or groups of specific microorganism, resulting in progressive


destruction of the periodontal ligament and alveolar bone with pocket formation, recession, or
both
penyakit radang pada jaringan pendukung gigi yang disebabkan oleh mikroorganisme spesifik
atau sekumpulan mikroorganisme yang spesifik, yang menyebabkan kerusakan progresif dari
ligamen periodontal dan tulang alveolar dengan pembentukan poket, resesi, atau keduanya
the current concept of etiology of periodontitis considers three groups of factors that determine
wether active periodontitis will occur in a subject :
1. suspectible host
!he susceptibility of the host is partially hereditary but can be influenced by
environmental and behavioral factors, such as smoking, stress, and diabetes. "ecently,
genetic variations or mutations have been identified that modulate the individual#s
response to the intraoral bacterial insult $contoh : inade%uate or unregulated
immunologic response& and that are associated with severe forms of periodontal
disease.
'. !he presence ofpathogenic species
!he second essential factorfor disease initiation and progression is the presence of one
or more pathogens, of the susceptible clonal type and in sufficient number. (espite the
difficulties inherent in characteri)ing the microbiology of periodontal disease, a small
group of pathogens is recogni)ed because of their close association with disease. !here
are obvious data consider actinobacillus actinomycetemcomitans, tannerella forsythia,
and porphyromonas gingivalis as key pathogens because they are strongly associated
with periodontal disease status, disease progression and unsuccessful therapy. *or the
following bacteria, however, moderate evidence for etiology has been reported, at least if
their concentration passes a certain threshold level:
+ Prevotella intermedia
+ Prevotella nigrescens
+ ,ampylobacter rectus
+ Peptostreptococcus micros
+ *usobacterium nucleatum
+ -ubacterium nodatum
+ .arious spyrochetes
!he significance for the role of these key pathogens is largely based on epidemiologic data, the
ability of these microorganisms to produce disease when inoculated in animals, and their
capacity to produce virulence factors. /owever, the mere presence of putative periodontal
pathogens in the gingival cervice is not sufficient to initiate or cause periodontal inflammation.
n elevation in the relative proportion or number of these pathogens to reach a critical mass
seems more crucial to mount an effective tissue+damaging process. 0ndeed, even in health,
periodontal pathogens may be present in the gingival crevice, although in low numbers, as
members of the normal resident flora.
1. !he absence, or a small proportion of benefical bacteria
!he role of beneficial species of the host is less obvious in the progression of disease.
2uch bacteria can affect disease progression in different ways :
a. 3y passively occupying a niche that may otherwise be coloni)ed by pathogens
b. 3y actively limiting a pathogen#s ability to adhere to appropriate tissue surfaces
c. 3y adversely affecting the vitality or growth of pathogen
d. 3y affecting the ability of a pathogen to produce virulence factors
e. (egrading virulence factors produced by the pathogen
4ne well documented e5ample such a beneficial action is the effect of streptococcus
sanguins on a.actinomycetemcomitans . s. sanguins produces hydrogen pero5ide which
either directly or by host+en)yme amplification can kill a. actinomycetemcomitans.
41 Etiology of Periodontitis
Interaction between Dental
Plaque and the Host
Bacteria
1 The primary etiologic factor for the existence of periodontitis is pathogenic microorganisms within
the subgingival biofilm.
Host
2 The genetically determined non-specific and specific immune responses, as well as systemic
syndromes and diseases influence the existence and the clinical course of periodontitis.
3 Habits and the patients own approach to general health will influence plaue formation and host
immune response, both systemically and particularly with regard to oral health.
4 !ocial circumstances influence the systemic and psychic well being of the patient. "roblems in the
socioeconomic arena lead to negative stress.
"sychic burdens and stress influence the immune status.

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