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.