pathogenesis of plaque associated periodontal diseases,orange complex

1. Pathogenesis of plaque associated
periodontal disease
Orange complex
DDS 4.
April 29, 2019
1

2. layout
 Introduction
 Orange complex
 Conclusion
 references
April 29, 2019
2

3. introduction
 The bacteria colonizing the hard and soft tissues of the
oral cavity are known to profoundly influence the oral
health and disease
 Scientists have realized that it is impossible to fully
understand oral health and disease without identifying
and understanding the pathogenic potential of all the
bacteria that colonize the oral cavity
 Over 700 species of bacteria have been identified in
the oral cavity.
 Over 400 these species have been identified from
periodontal pocket,
April 29, 2019
3

4. Introduction
 The remaining 300 species have been identified from
other sites such as tongue , oral mucous membrane ,etc.
 Most of the bacteria are harmless and commensals
 But clinical and experimental evidences confirm that some
strains of bacteria in the periodontal region can induce
gingival tissue inflammation and bone destruction
April 29,
2019
4

5. introduction
 Socransky and haffajee (1998) examined over
13,000 subgingival plaque samples from 185
subjects
 They identified 6 specific microbial groups or
bacterial complexes and label by color
 Classification based on
-presence in the biofilm and subgingival area
-involvement in pathogenesis of periodontal
disease
April 29,
2019
5

6. introduction
April 29, 2019
6

7. introduction
 Composition of different complexes is based on the
frequency with which microorganisms are recovered
together
 Purple ,yellow and green complexes were associated
with healthy periodontium
 Orange and red complexes and not grouped ones
comprised of species thought to be major pathogens
for periodontal diseases
 Member of red and orange complexes were
prevalent individuals with deep pockets
April 29, 2019
7

8. introduction
 Members of red complex are rarely found in absence
of members orange complex
 Usually colonization by orange complex precedes
colonization by the red complex
April 29, 2019
8

9. Orange complex
 This complex is constituted by ;
 Fusobacterium nucleatum
 Prevotella intermedia
 Prevotella nigrescens
 Peptostreptococcus micros
 Eubacteriam nodatum
 Streptococcus costellatus
 Campylobacter showae
 Campylobacter rectus and
 Campylobacter graciis April 29, 2019
9

10. PREVOTELLA INTERMEDIA
 Gram -ve,short and round- ended anaerobic rod
 Association ;acute necrotizing ulcerative gingivitis(ANUG)-
Loesche et al 1982
-certain forms of periodontitis-Tanner et al
- progressive sites in chronic periodontitis-
Tanner et al
 This species appears to have a number of virulence properties
exhibited by P. gingivalis
 Shown to induce the release of MMP-8,9 and invade oral
epithelial cells
 Shown to induce mixed infections in laboratory animals
 Elevated serum antibodies to this species have been observed
in some but not all subjects with periodontitis April 29, 2019
10

11. FUSOBACTERIUM
NUCLEUTUM
 Gram –ve, anaerobic, spindle(cigar) shaped rod
 Isolated from most of subgingival plaque samples
 prevalent in subjects with periodontitis and
periodontal abscess
 Invasion of this species into the gingival epithelial cells
in vitro was accompanied by an increase of IL-8 from
those cells
 Induce apoptosis in MNC and PMN
 Cytokines , elastase and oxygen radical release from
leukocytes
April 29, 2019
11

12. Campylobacter rectus
 Earlier called wolinella rectus
 Gram –ve, anaerobic ,short , motile vibrio
 Utilizes H2 or formate as energy source
 Seen in higher numbers in disease sites as compared
to healthy sites and more in sites exhibiting active
periodontal destruction
 Associated with periodontitis subjects with NIDDM
 Found in lower numbers after successful periodontal
therapy
April 29, 2019
12

13. Campylobacter rectus
 Like A. actinomycetemcomitans produce leukotoxin
 Capable of stimulating human gingival fibroblast to
produce IL-6 and IL-8
April 29, 2019
13

14. Peptostreptococcus micros
 Gram +ve, anaerobic, small, asaccharolytic coccus
 Seen in higher numbers at sites of periodontal
destruction as compared with healthy sites
 In combination with either P. intrmedia or P. nigrescens
could produce transmissible abscesses
 Produces protease
April 29, 2019
14

15. Eubacterium nodutum
 Gram +ve ,obligate anaerobe, small ,somewhat
pleomorphic rods
 Increased in numbers in disease sites, particularly
those of severe periodontitis
 Elicited elevated antibody responses in subjects with
different forms of destructive periodontitis
April 29, 2019
15

16. conclusion
 Some of periodontal conditions are associated with specific
microorganism
 Targeting these organisms during periodontal therapy will bring
better result and prognosis
 It is challenging to isolate the responsible species from the lesion
because a lesion may contain large number of pathogens, some
organism are difficult to culture
April 29, 2019
16

17. references
 Clinical periodontology,12th edition ,pg 141 e.1 by Carranza
 Clinical periodontology and implant dentistry,6th edition by
jan lindhe pg 223, 230, 231, 442
 Microbiology of periodontal diseases handout by dr.lilian
 Vladmir panov(2013) article of microbiology of periodontal
diseases
April 29, 2019
17

18. Thank you
April 29,
2019
18