Viruses may play a role in periodontal disease beyond just bacteria. The document discusses several viruses that have been found in periodontal tissues and fluid, including herpes viruses, HIV, HPV, and cytomegalovirus. These viruses can directly damage tissues, induce an inflammatory response, or suppress the immune system in ways that allow pathogenic bacteria to overgrow and cause periodontal disease. While bacteria remain a primary cause, evidence suggests certain viruses may activate from a latent state and contribute to the progression of gingivitis into destructive periodontitis.

1. Viruses, are they
culprits of periodontal
disease
Sai Deepika
3rd BDS
Dept of periodontics

2. Contents
 Introduction
Herpes viruses
herpes simplex
ebstein-barr virus
human cytomegalovirus
Human immunodefiency virus
Human papilloma virus
Conclusion

3. Introduction
Periodontal diseases are multifactorial in nature and many
etiological agents are suggested to play a role in their
etiopathogenesis.
Until recently, specific bacteria were considered the major
pathogens for the disease. The current evidence strongly
suggests the presence of many strains of viruses in the
periodontal environment.
Periodontal disease
gingivitis periodontitis

4. Various viruses like HIV, Herpes
simplex viruses, human papilloma
viruses, ebstein bar viruses, cytomegalo
viruses, Entero virus species Coxsacki
virus play an important role in
periodontal diseases

5. Herpes viruses
Herpes viruses can lead to the development of severe types of
periodontitis, and outlines potential mechanisms by which it
contributes to periodontal tissue breakdown.
Data in the literature
suggest an increased
frequency of detection of
specific members of the
Herpes viridae family,
such as EBV-1, HCMV,
and herpes simplex virus
(HSV) in various forms of
periodontal disease.

6. Mechanism
Healthy gingiva
Bacterial plaque
Gingivitis influx of inflammatory cells
containing latent herpesviruses
Herpesvirus activation immunosuppression,infection,
stress, hormones, etc.
Periodontopathic propertycytokines,
immunosuppression, direct cytotoxicity,overgrowth of
pathogenic bacteria
Destructive periodontal disease

7. Herpes simplex viruses
Infections HSV-1 and HSV-2 are worldwide spread and usually
affect skin and mucosa. HSV 1 most commonly effects the oral
cavity causing various lesions.
Recurrent herpetic
gingivostomatitis and
chronic herpetic
gingivostomatitis in
immunocompromised
Patients are some of the
clinical features of
herpes virus infection on
periodontium.

9. Ebstein–Barr virus
Ebstein–Barr virus affects over 90% of humans and is
usually transmitted by oral secretions or blood. The virus
replicates in epithelial cells or B cells of the oropharynx.
Most common symptoms of infectious mononucleosis
are fever, lymphadenopathy and pharyngitis. Oral ulcers,
palatal petechia and less commonly gingival ulcerations,
periodontitis Recurrent aphthous stomatitis, infectious
mononucleosis .

10. Human
cytomegalovirus
Human cytomegalovirus infests mainly the t lymphocytes and
macrophages. The gB protien in the viron envelop participates
in virus- cell interaction and is a major target of immune
response.
Human cytomegalovirus is the most common cause of
congenital and perinatal infections. HCMV infects
many different epithelial cells, endothelial cells,
smooth muscle cells, mesenchymal cells, hepatocytes,
granulocytes and monocyte-derived macrophages and
hence causing various periodontal diseases.

11. Human immunodefiency virus
HIV is associated with the following periodontal conditions:
linear gingival erythema (LGE), necrotizing gingivitis (NG),
necrotizing periodontitis (NP), and chronic periodontitis
HIV causes decrease in
CD4 call count which
makes the person prone
to various bacterial
infections effecting
periodontium and
causing periodontal
disease

12. Clinical features :
Linear gingival erythema is defined as a distinct
erythematous band of marginal gingiva with either diffuse or
punctuate erythema of the attached gingiva .
Linear marginal erythema

13. Most studies show a higher prevalence of NG and NP in HIV
infected patients than in non-HIV infected patients
NG results in the destruction of one or more interdental papillae
and remains confined to the marginal gingiva. NP extends beyond
the marginal gingiva, involves the periodontal ligament and the
alveolar bone, leading to a loss of attachment. NS extends past the
mucogingival line into the mucosa and osseous tissue.
Necrotizing ulcerative periodontitis

15. Human papilloma virus
Human papilloma virus (HPV) has also been known to
contribute to periodontal infection.
Mechanism:
HPV causes characteristic cytopathic effects (koilocytosis) and
proliferation of epithelial cells.
proliferation and migration of the junctional epithelium are a
major hallmark of periodontal breakdown and hence causing
periodontal disease.

16. Theoretically, the junctional epithelium attached to the tooth
surface appears to fully serve the cellular functions required by
HPV. It has a basal cell like phenotype and does not differentiate.
The basal cells are exfoliated through the gingival crevice before
differentiation occurs.
HPV virus mainly causes
oral cancers , tumors and
periodontitis.
Other less common viruses like picornavirus, enterovirus,
coxsackie virus can cause periodontal disease to an extent

17. Conclusion
Several studies, most of them from the same research
group, have demonstrated an association of herpes
viruses with periodontal disease. Viral DNA has been
detected in gingival tissue, GCF and subgingival
plaque from periodontaly diseased sites. In addition
markers of herpes viral activation have been
demonstrated in the GCF from periodontal lesions.
Active HCMV replication in periodontal sites may
suggest that HCMV reactivation triggers periodontal
disease activity