3periodontal disease aetiology and pathogenesis牙周疾病的病因学和病理学

PeriodontalCopyright©CGorrelCopyrightCopyright©CGorrelCopyrightCopyright©CGorrelWhatisPeriodontalCollective que-inducedinfl tionofperiodontal牙 noclinicallyevidenttissue clinicallyevidenttissue Aetiology Copyright©CGorrelCopyrightCopyright©CGorrel CopyrightCopyright©CGorrel 些难以直接粘附到基质表面的革兰氏菌 环境的变化，的厌氧性革兰氏菌形成次级菌落，这些细Copyright©CGorrel 唾液粘蛋白Copyright©CGorrel

CopyrightCopyright©CGorrelDentalque=Stable‘eco-system’withamplenutrientEffectivelyprotectbacteriafromanti-microbialagentsCalculus=mineralisedSupra-gingivalcosmetic齿龈上=Sub-gingivalofpathogenicsignificance齿龈下=Dentalcalculus牙Dentalcalculus=mineralizedItisalwayscoveredbyalayerofDirectinjurybyqueIndirectinjuryvia Itisthehost’sresponsetothequebacteriaratherthanmicrobialvirulencepersethatdirectlycausesthetissuedamageCopyrightCopyright©CGorrelMicrobialMicrobialvirulence•Fimbriaepiliadhesins•Capsuleantihaoctic•LPSendotoxin•Cellwallcom etidolcan,techoicmacrophagetoxicity,lysozyme细胞壁成分（肽聚糖，techoicacid）：巨噬细胞毒性，溶ExotoxinsEnzymese.gproteasesHostdefenseInnate(non-specific)=firstlinedefense AdativesecificsecondlineofInnateInnatedefenseprocesses= toThetoll-likereceptorsTLR’soncellsarepattern-Whichrecognizemicro-associatedmolecularpatternsTLR’sreada“barcode”onmicrobes,whichisthendecodedintracellularlytotailortheappropriatetypeofinnateresponseSystemdoesnotreadilydistinguishbetweenpathogensCopyright©CGorrel

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Extentandcompositionof toryCopyright©CGorrelEpithelialproliferationingingivitisCopyright©CGorrelApicalmigrationofepitheliumandbonelossinCopyright©CGorrelCopyrightCopyright©CGorrelPeriodontalPeriodontaldisease operateingingivaltissuestoprotectagainstlocalmicrobialattackandreventmicrooranismsortheirdamagingproductsformspreadingintoorinvadingthetissues或其产生的有害物质蔓延或组织The‘protective’hostdefensereactionsdamagethetissuesandcontributetothetissuedestructionseenin inivitisandperiodontitisAnatomyoftheperiodontium–thepermeablejunctionalepitheliumthathasremarkablecellandfluiddynamics,withitsprimepurposetopreserveepithelialcontinuityacrossthehardandsofttissueinterfaceThe“defensiveprocesses”intheeriodontaltissuesoccurinres onsetoalargenumberandvarietiesofmicrobesthatr surfaceinabiofilmcommunity,closetoratherthanwithinthegingivaCopyright©CCopyright©CGorrelCopyrightCopyright©CGorrelThemicroorganismsinthebiofilm,especiallywhenpocketinghasoccurredareinacontinualstageoffluxTissuedestruction yr ltfromcombinationsofbacterialfactorswhichvaryovertimeThepathogenicityfmirrnimrl mhthehost’sinnateand/oradaptivecapabilitiesastothevirulenceofthebacteriathemselves TheWorldWorkshopinPeriodontologyReport1996)designatedA.itans,P.gingivalisT.forsythiaasperiodontal牙周病学研讨会（1996）牙龈卟啉单胞菌和T.forsythia是牙周病的致病菌P.gulae??InPeriodontaldisease–uniqueWithinthesameindividualtheseverityofperiodontaltissueinjuryoftenvariesfromtoothtotoothandfromonetoothsurfacetoanother在同一个上，不同牙齿或者同一牙齿的不同表面SitespecificPeriodontalItisstillnotunderstoodwhyinsomepatientsthelesionsremainconfinedtothemarginalportionofthegingivaltissues,whileinothersusceptiblepatientstheyprogresstoinvolvemoreapicalportionsoftheperiodontiumandcauselossofperiodontalatta entandbonePeriodontalTheThesameholdstrueforsiteswithinasusceptible Imbalanceofhost-parasiterelationshipisoccurringinthedestructivelesionsGingivalGingival Copyright©CGorrelCopyrightCopyright©CG