This document summarizes the pathogenesis of plaque-associated periodontal disease caused by the orange bacterial complex. The orange complex is composed of Fusobacterium nucleatum, Prevotella intermedia, Prevotella nigrescens, Peptostreptococcus micros, Eubacterium nodatum, Streptococcus costellatus, Campylobacter showae, Campylobacter rectus, and Campylobacter graciis. Members of the orange complex are associated with periodontal diseases and have been shown to invade tissues, induce cytokine production, and elicit antibody responses. Periodontal therapy targeting these pathogenic bacteria may help improve treatment outcomes.

1. Pathogenesis of plaque associated
periodontal disease
Orange complex
DDS 4.
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2. layout
 Introduction
 Orange complex
 Conclusion
 references
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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,
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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
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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
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6. introduction
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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
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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
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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
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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
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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
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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
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13. Campylobacter rectus
 Like A. actinomycetemcomitans produce leukotoxin
 Capable of stimulating human gingival fibroblast to
produce IL-6 and IL-8
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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
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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
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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
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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
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18. Thank you
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