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Dr Harshavardhan G Patwal
INTRODUCTION
HISTORY
NORMAL MICROFLORA OF HUMAN ORAL CAVITY
MICROFLORA OF PERIODONTAL DISEASE
VIRULENCE FACTORS
BACTERIA IN PATHOGENESIS OF PERIODONTAL DISEASE
MICROBIAL DIAGNOSIS
CONCLUSION
INTRODUCTION
• FROM AMOEBA TO Aa, Pg
• BACTERIAL PLAQUE- CAUSATIVE OF
PERIODONTAL DIS
• LARGE COMPLEX MIXTURE OF BACTERIAL
SPECIES
HISTORY
• 1683 - ANTON VON LEEWENHOEK
• 1890 - WD MILLER
• 1965 - LOE, THEILADE AND JENSEN
• 1880 TO 1890 – AMOEBAE, SPIROCHETES,
MILLER’S BACTERIA, STREPTOCOCCI
• 1890 – 1930 SPECIFICITY THEORY
• 1930 – 1970 NONSPECIFICTY THEORY
• 1970 ONWARD RETURN OF SPECIFICITY THEORY
NORMAL FLORA
• 300 – 400 SPECIES FOUND IN HUMAN
SUBGINGIVAL PLAQUE
• INDIGENOUS FLORA
• SUPPLEMENTAL FLORA
• TRANSIENT FLORA
FACTORS INFLUENCING NORMAL FLORA
• THE ENVIRONMENT THE INDIVIDUAL IS RAISED
• THE DIET
• ORAL HYGIENE HABITS
• INFECTION POTENTIAL FROM FAMILLY MEMBERS
• INFECTION POTENTIAL FROM PETS
• TOOTH ERUPTION
• PRESENCE OF PERIODONTAL POCKET
• HORMONAL EFFECTS
• PERIODIC EXPOSURE TO VARIOUS TREATMENT
ACQUISITION OF BACTERIA
• STARTS AT BIRTH
• DERIVED FROM FROM THE IMMEDIATE
ENVIRONMENT
• MODULATED BY HOST FACTORS
SUBGINGIVAL FLORA ASSOCIATED WITH HEALTH
• STREPTOCOCCUS MITIS
• S SANGUIS
• S EPIDERMIDIS
• ROTHIA DENTOCARIOSA
• ACTINOMYCES VISCOSUS
• ACTINOMYCES NAESLUNDII
• SMALL SPIROCHETES
RELATIVE PROPORTION OF
MICROORGANISMS
MICROBIAL FLORA OF
PERIODONTAL DISEASE
CONCEPTS OR HYPOTHESISES – WALTER LOESCHE 1976
 NONSPECIFIC – THE ENTIRE PLAQUE FLORA IS
RESPONSIBLE
 SPECIFIC – ONLY CERTAIN PLAQUE IS PATHOGENIC
RANKING OF SUSPECTED BACTERIAL
PATHOGENS
MODERATE
• S intermedius
• P micros
• F nucleatum
• E corrodens
• Eubacterium
STRONG
• P intermedia
• C rectus
• E nodatum
• Treponema sp
VERY STRONG
• A actinomycetemcomitans
• P gingivalis
• B forsythus
VIRULENCE FACTORS
VIRULENCE - THE QUALITY OF BEING DAMAGING;
THE DISEASE PRODUCING POWER OF A
MICROORGANISM
GLOSSARY OF PERIODONTAL TERMS
1984
OTHER FACTORS :
 CONCENTRATION OF MICROORGANISMS
VIRULENCE FACTORS
1. THE CAPACITY TO COLONIZE
2. THE ABILITY TO EVADE ANTIBACTERIAL HOST
DEFENSE
3. THE ABILITY TO PRODUCE SUBSTANCES THAT CAN
DIRECTLY OR INDIRECTLY INITIATE TISSUE
DESTRUCTION
COLONIZATION
FACTORS INFLUENCING COLONIZATION
1. AVAILABILTY OF SURFACES TO ATTACH
2. ABILITY TO MULTIPLY
3. ABILITY TO COMPETE SUCCESSFULLY AGAINST
OTHER MICROORGANISMS
ATTACHMENT
SITES FOR ATTACHMENT
1. THE TOOTH
2. THE SULCULAR / POCKET EPTHELIUM
3. OTHER BACTERIAL SPECIES
BACTERIAL FACTORS FACILITATING ATTACHMENT
1. ADHESINS
2. COAGGREGATION
ADHESINS
1. FIMBRIAE
a. TYPE --1
b. TYPE –2
c. TYPE –3
d. TYPE – 4
2. CELL ASSOCIATED PROTEINS
a. 300-330 kDa PROTEIN
b. 70, 90 kDa PROTEIN
c. 40 kDa PROTEIN
RECEPTORS FOR ADHESINS ON TISSUE SURFACES
• GALACTOSYL VESICLES
• SIALIC ACID
• PROLIN-RICH PROTEINS OR STATHERIN
• TYPE-I AND IV COLLAGEN
FIMBRIAE
ADHESINS ORGANISM
FIMBRIAE E corrodens
A viscosus
PROTEINS
F nucleatum (300-330 kDa protein)
T denticola
P gingivalis
Streptococcus mitis (70, 90 kDa protein)
B loeschei ( fimbriae associated 75 & 45
kDa polypeptide)
EXAMPLES OF ADHESINS
RECEPTOR ADHESINS SITE ORGANISMS
GALACTOSYL
RESIDUE
PROTEIN
FIMBRIAE
EPITHELIAL CELLS
FIBROBLASTS
PML
SALIVA COATED
SURFACES
E corrodens (PROTEIN)
B gingivalis (FIMBRIAE)
A viscosus (TYPE 2
FIMBRIAE)
A naeslundii (FIMBRIAE)
T denticola (PROTEIN)
F nucleatum (300-330 kDa
Protein)
B loeschi (FIMBRIAE)
SIALIC ACID PROTEIN SALIVA COATED
SURFACES
S mitis (70, 90 kDa
PROTEIN)
PROLIN-RICH
PROTEINS OR
STATHERIN
FIMBRIAE MINERALIZED SURFACES A viscosus (TYPE 1
FIMBRIAE)
TYPE-I AND IV
COLLAGEN
BASEMENT MEMBRANE B gingivalis ( NOT KNOWN)
MANNOSE RESIDUE PROTEIN FIBROBLASTS T denticola (PROTEIN)
SALIVA TREATED
HYDROXYAPPATITE
FIMBRIAE MINERALIZED SURFACES A viscosus (TYPE 1
FIMBRIAE)
KNOWN RECEPTORS FOR BACTERIAL ADHESINS
COAGGREGATION
Sl. No. TARGET SPECIES RECEPTOR ON
TARGET SPECIES
SPECIES ADHESINS
1 B gingivalis GALACTOSYL
RESIDUE
F nucleatum PROTEIN
2 S sanguis GALACTOSYL
RESIDUE
B loeschi FIMBRIAE
ASSOCIATED
75 AND 45 kDa
POLYPEPTIDE
3 S sanguis GALACTOSYL
RESIDUE
A viscosus TYPE 2
FIMBRIAE
4 S sanguis POLYSACCHARIDE
WITH REPEATING
HEPTASUCCINATE
A viscosus FIMBRIAE
MULTIPLICATION OF BACTERIA
FACTORS INFLUENCING MULTIPLICATION
1. CREVICE TEMP
2. GCF pH
3. OXIDATION REDUCTION POTENTIAL
4. AVAILABLE NUTRIENTS
INTERBACTERIAL RELATIONSHIP
• FAVORABLE RELATIONSHIP
• FACILATITING ATTACHMENT
• PRODUCING GROWTH FACTORS
– BRANCED CHAIN FATTY ACIDS
– POLYAMINES
– VITAMIN K ANALOGUES
– LACTATE / FORMATE /HYDROGEN
• PRODUCTION OF EXTRACELLULAR ENZYMES THAT
UNCOVER BINDING SITES FOR ONOTHER
ORGANISM
 ANTAGONISTIC RELATIONSHIP
• COMPETITION FOR NUTRIENTS
• COMPETITION FOR SITE
• PRODUCTION OF SUBSTANCES LIMITING /
PREVENTING GROWTH
INTERRELATIONSHIP FOR NUTRITION
O2
SUGAR
CO2
SALIVA DIET
GCF
SALTS
NH4
AMINO ACIDS
STRPTOCOCCUS
ACTINOMYCES
PABA
S MUTANS
CAPNOCYTOPHAGA
E CORRODENS
Aa
FUSOBACTERIUM
EUBACTERIUM
BACTEROIDS
PEPTOCOCCUS
PEPTOSTREPTOCOCCUSA
Thiamin pyroP
Putrescine
isobutyrate
CO2
NH4
T macrodentium
lactate
Veillonella acetate
Eubacterium
H2
Campylobacter
Wolinella
formate
P melaninogenicus
P gingivalis
Hemin
OVERCOMING HOST DEFENSE
Sl. No DEFENSE
MECHANISM
VIRULENCE FACTOR SPECIES
1 SPECIFIC Ab
IgA, IgG PROTEASE B gingivalis
B intermedia
B melaninogenicus
Capnocytophaga
2 SALIVARY
MACROMOLECULES
AFFINITY FOR HIDDEN RECEPTORS
(CRYTITOPES)
A viscosus
3 PNL
LEUKOTOXIN Aa
CAPSULE B gingivalis
INHIBITION OF DEGRANULATION T denticola
INHIBITION OF SUPEROXIDE PRODUCTION Treponema
4
LYMPHOCYTE
LEUKOTOXIN – LETHAL Aa
LEUKOTOXIN – NONLETHAL SUPPRESION Aa
SUPPRESSED IMMUNE RESPONSE B intermedia
INHIBIT RESPONSE TO MITOGENS AND
ANTIGENS
B intermedia
B endodontalis
T denticola
Aa
5 ANTIBIOTIC
THERAPY
CONJUGAL TRANSFER OF RESISTANCE
PLASMID
T denticola
B intermedius
FACTORS CAUSING TISSUE DAMAGE
Sl. No. ENZYMES SPECIES
1 COLLAGENASE P gingivalis
Aa
2 PROTEASE P gingivalis
P intermedia
3 KERATINASE P gingivalis
T denticola
4 ARYL SULFATASE W recta
5 NEURAMINADASE P gingivalis
B forsythus
P melaninogenicus
6 FIBRONECTIN DEGRADING
ENZYMES
P gingivalis
P intermedia
7 PHOSPHLIPASE P intermedia
P melaninogenicus
BACTERIAL PREPARATION INHIBITING
MAMMALIAN CELL GROWTH
Sl. No. BACTERIAL PREPARATIONS ORGANISM AFECTED CELLS
1 CULTURE SUPERNATANTS P gingivalis FIBROBLASTS
2 LPS Aa FIBROBLASTS
3 CAPSULE Aa FIBROBLASTS
4 SONIC EXTRACTS P gingivalis
T denticola
FIBROBLASTS
5 SONIC EXTRACTS Aa
P gingivalis
EPITHELIAL CELLS
ENDOTHELIAL CELLS
Environmental and acquired risk factor
Hostimmuno-inflammatory
response
Ct&bonemetabolism
Clinicalsignsofdisease
initiation&progression
Genetic risk factor
Cytokines
MMPs
Ab
PMN s
Ag
LPS
Other
virulence factors
Microbial
challenge
MECHANISM OF PERIODONTAL DISEASE
PRODUCTION
BACTERIA ASOCIATED WITH SPECIFIC
PERIODONTAL DISEASE
DISEASE ORGANISM
ADULT PERIODONTITIS P gingivlis, P intermedia, B forsythus, C rectus, E
corrodens, F nucleatum,
REFRACTORY PERIODONTITIS B forsythus, P gingivlis, C rectus, P intermedia
LJP Aa, Capnocytophaga
PRAGNENCY GINGIVITIS P intermedia
ANUG P intermedia, Intermediate-sized spirochetes
PERIODONTITIS IN JUVENILE
DIABETICS
Capnocytophaga, Aa
PERIODONTAL ABSCESSES P gingivalis, Fusobacterium, Capnocytophaga,
Vibrio sp
MICROBIAL DIAGNOSIS
OF PD
• MICROSCOPIC ASSAYS
• CULTURE ASSAYS
• IMMUNOLOGIC ASSAYS
– ELISA
– IMMUNOFLUORESCENCE
• DNA PROBE ASSAY
• ENZYME-BASED ASSAYS
AVAILABLE DIAGNOSTIC AIDS
• CULTURE
Aa P gingivalis
P intermedia Capnocytophaga
Wolinella Sp Eikenlla Sp
Peptostrptococcus micros
• DNA PROBE
Aa B forsythus
P gingivalis C rectus
• BANA
T denticola B forsythus
P gingivalis
CONCLUSION
• COMPLEXITY IS THE PRINCIPAL PROBLEM
• REMARKABLE RESEARCH EFFORTS HAVE
RESULTED IN UNDERSTANDING THE MICROBIAL
ETIOLOGY
• MORE WORK REQUIRED TO DEVELOP
DIAGNOSTIC TESTS
Oral microbiology-  Dr Harshavardhan Patwal

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Oral microbiology- Dr Harshavardhan Patwal

  • 2. INTRODUCTION HISTORY NORMAL MICROFLORA OF HUMAN ORAL CAVITY MICROFLORA OF PERIODONTAL DISEASE VIRULENCE FACTORS BACTERIA IN PATHOGENESIS OF PERIODONTAL DISEASE MICROBIAL DIAGNOSIS CONCLUSION
  • 3. INTRODUCTION • FROM AMOEBA TO Aa, Pg • BACTERIAL PLAQUE- CAUSATIVE OF PERIODONTAL DIS • LARGE COMPLEX MIXTURE OF BACTERIAL SPECIES
  • 4. HISTORY • 1683 - ANTON VON LEEWENHOEK • 1890 - WD MILLER • 1965 - LOE, THEILADE AND JENSEN • 1880 TO 1890 – AMOEBAE, SPIROCHETES, MILLER’S BACTERIA, STREPTOCOCCI • 1890 – 1930 SPECIFICITY THEORY • 1930 – 1970 NONSPECIFICTY THEORY • 1970 ONWARD RETURN OF SPECIFICITY THEORY
  • 5. NORMAL FLORA • 300 – 400 SPECIES FOUND IN HUMAN SUBGINGIVAL PLAQUE • INDIGENOUS FLORA • SUPPLEMENTAL FLORA • TRANSIENT FLORA
  • 6. FACTORS INFLUENCING NORMAL FLORA • THE ENVIRONMENT THE INDIVIDUAL IS RAISED • THE DIET • ORAL HYGIENE HABITS • INFECTION POTENTIAL FROM FAMILLY MEMBERS • INFECTION POTENTIAL FROM PETS • TOOTH ERUPTION • PRESENCE OF PERIODONTAL POCKET • HORMONAL EFFECTS • PERIODIC EXPOSURE TO VARIOUS TREATMENT
  • 7. ACQUISITION OF BACTERIA • STARTS AT BIRTH • DERIVED FROM FROM THE IMMEDIATE ENVIRONMENT • MODULATED BY HOST FACTORS
  • 8. SUBGINGIVAL FLORA ASSOCIATED WITH HEALTH • STREPTOCOCCUS MITIS • S SANGUIS • S EPIDERMIDIS • ROTHIA DENTOCARIOSA • ACTINOMYCES VISCOSUS • ACTINOMYCES NAESLUNDII • SMALL SPIROCHETES
  • 10. MICROBIAL FLORA OF PERIODONTAL DISEASE CONCEPTS OR HYPOTHESISES – WALTER LOESCHE 1976  NONSPECIFIC – THE ENTIRE PLAQUE FLORA IS RESPONSIBLE  SPECIFIC – ONLY CERTAIN PLAQUE IS PATHOGENIC
  • 11. RANKING OF SUSPECTED BACTERIAL PATHOGENS MODERATE • S intermedius • P micros • F nucleatum • E corrodens • Eubacterium STRONG • P intermedia • C rectus • E nodatum • Treponema sp VERY STRONG • A actinomycetemcomitans • P gingivalis • B forsythus
  • 12. VIRULENCE FACTORS VIRULENCE - THE QUALITY OF BEING DAMAGING; THE DISEASE PRODUCING POWER OF A MICROORGANISM GLOSSARY OF PERIODONTAL TERMS 1984 OTHER FACTORS :  CONCENTRATION OF MICROORGANISMS
  • 13. VIRULENCE FACTORS 1. THE CAPACITY TO COLONIZE 2. THE ABILITY TO EVADE ANTIBACTERIAL HOST DEFENSE 3. THE ABILITY TO PRODUCE SUBSTANCES THAT CAN DIRECTLY OR INDIRECTLY INITIATE TISSUE DESTRUCTION
  • 14. COLONIZATION FACTORS INFLUENCING COLONIZATION 1. AVAILABILTY OF SURFACES TO ATTACH 2. ABILITY TO MULTIPLY 3. ABILITY TO COMPETE SUCCESSFULLY AGAINST OTHER MICROORGANISMS
  • 15. ATTACHMENT SITES FOR ATTACHMENT 1. THE TOOTH 2. THE SULCULAR / POCKET EPTHELIUM 3. OTHER BACTERIAL SPECIES BACTERIAL FACTORS FACILITATING ATTACHMENT 1. ADHESINS 2. COAGGREGATION
  • 16. ADHESINS 1. FIMBRIAE a. TYPE --1 b. TYPE –2 c. TYPE –3 d. TYPE – 4 2. CELL ASSOCIATED PROTEINS a. 300-330 kDa PROTEIN b. 70, 90 kDa PROTEIN c. 40 kDa PROTEIN RECEPTORS FOR ADHESINS ON TISSUE SURFACES • GALACTOSYL VESICLES • SIALIC ACID • PROLIN-RICH PROTEINS OR STATHERIN • TYPE-I AND IV COLLAGEN
  • 18. ADHESINS ORGANISM FIMBRIAE E corrodens A viscosus PROTEINS F nucleatum (300-330 kDa protein) T denticola P gingivalis Streptococcus mitis (70, 90 kDa protein) B loeschei ( fimbriae associated 75 & 45 kDa polypeptide) EXAMPLES OF ADHESINS
  • 19. RECEPTOR ADHESINS SITE ORGANISMS GALACTOSYL RESIDUE PROTEIN FIMBRIAE EPITHELIAL CELLS FIBROBLASTS PML SALIVA COATED SURFACES E corrodens (PROTEIN) B gingivalis (FIMBRIAE) A viscosus (TYPE 2 FIMBRIAE) A naeslundii (FIMBRIAE) T denticola (PROTEIN) F nucleatum (300-330 kDa Protein) B loeschi (FIMBRIAE) SIALIC ACID PROTEIN SALIVA COATED SURFACES S mitis (70, 90 kDa PROTEIN) PROLIN-RICH PROTEINS OR STATHERIN FIMBRIAE MINERALIZED SURFACES A viscosus (TYPE 1 FIMBRIAE) TYPE-I AND IV COLLAGEN BASEMENT MEMBRANE B gingivalis ( NOT KNOWN) MANNOSE RESIDUE PROTEIN FIBROBLASTS T denticola (PROTEIN) SALIVA TREATED HYDROXYAPPATITE FIMBRIAE MINERALIZED SURFACES A viscosus (TYPE 1 FIMBRIAE) KNOWN RECEPTORS FOR BACTERIAL ADHESINS
  • 20. COAGGREGATION Sl. No. TARGET SPECIES RECEPTOR ON TARGET SPECIES SPECIES ADHESINS 1 B gingivalis GALACTOSYL RESIDUE F nucleatum PROTEIN 2 S sanguis GALACTOSYL RESIDUE B loeschi FIMBRIAE ASSOCIATED 75 AND 45 kDa POLYPEPTIDE 3 S sanguis GALACTOSYL RESIDUE A viscosus TYPE 2 FIMBRIAE 4 S sanguis POLYSACCHARIDE WITH REPEATING HEPTASUCCINATE A viscosus FIMBRIAE
  • 21. MULTIPLICATION OF BACTERIA FACTORS INFLUENCING MULTIPLICATION 1. CREVICE TEMP 2. GCF pH 3. OXIDATION REDUCTION POTENTIAL 4. AVAILABLE NUTRIENTS
  • 22. INTERBACTERIAL RELATIONSHIP • FAVORABLE RELATIONSHIP • FACILATITING ATTACHMENT • PRODUCING GROWTH FACTORS – BRANCED CHAIN FATTY ACIDS – POLYAMINES – VITAMIN K ANALOGUES – LACTATE / FORMATE /HYDROGEN • PRODUCTION OF EXTRACELLULAR ENZYMES THAT UNCOVER BINDING SITES FOR ONOTHER ORGANISM
  • 23.  ANTAGONISTIC RELATIONSHIP • COMPETITION FOR NUTRIENTS • COMPETITION FOR SITE • PRODUCTION OF SUBSTANCES LIMITING / PREVENTING GROWTH
  • 24. INTERRELATIONSHIP FOR NUTRITION O2 SUGAR CO2 SALIVA DIET GCF SALTS NH4 AMINO ACIDS STRPTOCOCCUS ACTINOMYCES PABA S MUTANS CAPNOCYTOPHAGA E CORRODENS Aa FUSOBACTERIUM EUBACTERIUM BACTEROIDS PEPTOCOCCUS PEPTOSTREPTOCOCCUSA Thiamin pyroP Putrescine isobutyrate CO2 NH4 T macrodentium lactate Veillonella acetate Eubacterium H2 Campylobacter Wolinella formate P melaninogenicus P gingivalis Hemin
  • 25. OVERCOMING HOST DEFENSE Sl. No DEFENSE MECHANISM VIRULENCE FACTOR SPECIES 1 SPECIFIC Ab IgA, IgG PROTEASE B gingivalis B intermedia B melaninogenicus Capnocytophaga 2 SALIVARY MACROMOLECULES AFFINITY FOR HIDDEN RECEPTORS (CRYTITOPES) A viscosus 3 PNL LEUKOTOXIN Aa CAPSULE B gingivalis INHIBITION OF DEGRANULATION T denticola INHIBITION OF SUPEROXIDE PRODUCTION Treponema 4 LYMPHOCYTE LEUKOTOXIN – LETHAL Aa LEUKOTOXIN – NONLETHAL SUPPRESION Aa SUPPRESSED IMMUNE RESPONSE B intermedia INHIBIT RESPONSE TO MITOGENS AND ANTIGENS B intermedia B endodontalis T denticola Aa 5 ANTIBIOTIC THERAPY CONJUGAL TRANSFER OF RESISTANCE PLASMID T denticola B intermedius
  • 26. FACTORS CAUSING TISSUE DAMAGE Sl. No. ENZYMES SPECIES 1 COLLAGENASE P gingivalis Aa 2 PROTEASE P gingivalis P intermedia 3 KERATINASE P gingivalis T denticola 4 ARYL SULFATASE W recta 5 NEURAMINADASE P gingivalis B forsythus P melaninogenicus 6 FIBRONECTIN DEGRADING ENZYMES P gingivalis P intermedia 7 PHOSPHLIPASE P intermedia P melaninogenicus
  • 27. BACTERIAL PREPARATION INHIBITING MAMMALIAN CELL GROWTH Sl. No. BACTERIAL PREPARATIONS ORGANISM AFECTED CELLS 1 CULTURE SUPERNATANTS P gingivalis FIBROBLASTS 2 LPS Aa FIBROBLASTS 3 CAPSULE Aa FIBROBLASTS 4 SONIC EXTRACTS P gingivalis T denticola FIBROBLASTS 5 SONIC EXTRACTS Aa P gingivalis EPITHELIAL CELLS ENDOTHELIAL CELLS
  • 28. Environmental and acquired risk factor Hostimmuno-inflammatory response Ct&bonemetabolism Clinicalsignsofdisease initiation&progression Genetic risk factor Cytokines MMPs Ab PMN s Ag LPS Other virulence factors Microbial challenge MECHANISM OF PERIODONTAL DISEASE PRODUCTION
  • 29.
  • 30.
  • 31. BACTERIA ASOCIATED WITH SPECIFIC PERIODONTAL DISEASE DISEASE ORGANISM ADULT PERIODONTITIS P gingivlis, P intermedia, B forsythus, C rectus, E corrodens, F nucleatum, REFRACTORY PERIODONTITIS B forsythus, P gingivlis, C rectus, P intermedia LJP Aa, Capnocytophaga PRAGNENCY GINGIVITIS P intermedia ANUG P intermedia, Intermediate-sized spirochetes PERIODONTITIS IN JUVENILE DIABETICS Capnocytophaga, Aa PERIODONTAL ABSCESSES P gingivalis, Fusobacterium, Capnocytophaga, Vibrio sp
  • 32. MICROBIAL DIAGNOSIS OF PD • MICROSCOPIC ASSAYS • CULTURE ASSAYS • IMMUNOLOGIC ASSAYS – ELISA – IMMUNOFLUORESCENCE • DNA PROBE ASSAY • ENZYME-BASED ASSAYS
  • 33. AVAILABLE DIAGNOSTIC AIDS • CULTURE Aa P gingivalis P intermedia Capnocytophaga Wolinella Sp Eikenlla Sp Peptostrptococcus micros • DNA PROBE Aa B forsythus P gingivalis C rectus • BANA T denticola B forsythus P gingivalis
  • 34. CONCLUSION • COMPLEXITY IS THE PRINCIPAL PROBLEM • REMARKABLE RESEARCH EFFORTS HAVE RESULTED IN UNDERSTANDING THE MICROBIAL ETIOLOGY • MORE WORK REQUIRED TO DEVELOP DIAGNOSTIC TESTS