This article is the first in a series outlining recent progress in periodontology and Periodontal Treatment in Houston, Texas.It tells about Heart Attacks, Strokes, Diabetes and Periodontal Diseases and Periodontal Treatment in Houston, Texas.
Within the last two years, great strides have been made in understanding the pathogenesis of periodontal diseases. Concurrent with this progress, correlations between periodontal diseases and systemic diseases are being recognized. We now better understand the relationship between diabetes and periodontal diseases. Recently, we have recognized that periodontal diseases may be risk factors for the development of atherosclerotic plaques and cardiovascular accidents including myocardial infarction and stroke. Further, a relationship appears to exist between periodontal diseases and low birth weight babies. To cover these topics, the following series of article will be published in this and future issues of the Journal.
I. New paradigms in the pathogenesis of periodontal diseases.
a. Periodontopathic bacteria and biofilms
b. Host responses and genetics
II. Periodontal diseases and cardiovascular diseases.
III. Periodontal diseases and diabetes.
IV. Periodontal diseases and low birth weight babies.
V. Recent advances in Periodontology: what it means for the practicing dentist.
This article will summarize the major points addressed in each of these areas.
New Paradigms in the Pathogenesis of Periodontal Diseases:
The role of bacteria in periodontal disease has been well established for many years. With time however, our concept of this infection has changed. In the 1930’s, we removed bone based upon G.V. Black's concept of "extension for prevention" and the belief that bone was infected. In the 1950's, we removed gingival tissues based upon the idea that this was the site of infection. In the 1960’s we came to realize that the bacteria causing periodontal disease were found predominantly on the root surface and that the bacteria seldomly invaded the host tissues. Thus, removal of bacteria from the tooth (root) surface by scaling and root planing became the predominant periodontal treatment of choice for treating early periodontal disease. Periodontal treatment in Houston, Texas with surgery was and still remains an important therapeutic modality for treating those patients in which root planing is ineffective at controlling inflammation, and for those patients needing regenerative therapy and mucogingival therapy.
Recently, the model has been advanced that subgingival plaque is a biofilm. Biofilms have been defined as matrix-enclosed bacterial population’s adherent to each other and/or to surfaces or interfaces. Biofilms allow for mutual survival of a large number of diverse bacteria. Within the biofilm, communities evolve that exhibit cooperativity. The matrix of the biofilm is thought to be a barrier to diffusion allowing for local accumulation or depletion of ions and molecules. In this matrix, the depletion of a molecule by metabolic activity of one bacterial species can. provide an environment for enhanced growth of another bacterial species. This symbiosis is thought to occur in the organization of bacteria in the gingival sullcus. Oxygen requiring aerobic bacteria are predominately found at the free gingival margin. Deeper in the pocket, facultative bacteria capable of surviving in varying oxygen levels survive. At the depth of the pocket, strict anerobic bacteria are found. Thus, oxygen is removed by the aerobic and facultative bacteria, providing the environment required for growth of the strict anerobic bacteria. Similarly, microenvironments with radically different pH and metabolic concentrations allowing for preferential growth of bacteria with fastidious growth requirements.
Biofilms are thought to provide additional resistance to the usual host defenses and antibiotics/antimicrobial agents. Thus, bacteria within the sulcus that are embedded in secreted extracellular material making up the biofilm have significantly reduced contact with antibodies, complement and host defense cells. Further, the extracellular material making up the matrix of the biofilm impedes exposure of the bacteria to antibiotics explaining the limited results we have seen with periodontal treatment in Houston, Texas using these agents.
Within the last two years, great strides have been made in understanding the pathogenesis of periodontal diseases. Concurrent with this progress, correlations between periodontal diseases and systemic diseases are being recognized. We now better understand the relationship between diabetes and periodontal diseases. Recently, we have recognized that periodontal diseases may be risk factors for the development of atherosclerotic plaques and cardiovascular accidents including myocardial infarction and stroke. Further, a relationship appears to exist between periodontal diseases and low birth weight babies. To cover these topics, the following series of article will be published in this and future issues of the Journal.
I. New paradigms in the pathogenesis of periodontal diseases.
a. Periodontopathic bacteria and biofilms
b. Host responses and genetics
II. Periodontal diseases and cardiovascular diseases.
III. Periodontal diseases and diabetes.
IV. Periodontal diseases and low birth weight babies.
V. Recent advances in Periodontology: what it means for the practicing dentist.
This article will summarize the major points addressed in each of these areas.
New Paradigms in the Pathogenesis of Periodontal Diseases:
The role of bacteria in periodontal disease has been well established for many years. With time however, our concept of this infection has changed. In the 1930’s, we removed bone based upon G.V. Black's concept of "extension for prevention" and the belief that bone was infected. In the 1950's, we removed gingival tissues based upon the idea that this was the site of infection. In the 1960’s we came to realize that the bacteria causing periodontal disease were found predominantly on the root surface and that the bacteria seldomly invaded the host tissues. Thus, removal of bacteria from the tooth (root) surface by scaling and root planing became the predominant periodontal treatment of choice for treating early periodontal disease. Periodontal treatment in Houston, Texas with surgery was and still remains an important therapeutic modality for treating those patients in which root planing is ineffective at controlling inflammation, and for those patients needing regenerative therapy and mucogingival therapy.
Recently, the model has been advanced that subgingival plaque is a biofilm. Biofilms have been defined as matrix-enclosed bacterial population’s adherent to each other and/or to surfaces or interfaces. Biofilms allow for mutual survival of a large number of diverse bacteria. Within the biofilm, communities evolve that exhibit cooperativity. The matrix of the biofilm is thought to be a barrier to diffusion allowing for local accumulation or depletion of ions and molecules. In this matrix, the depletion of a molecule by metabolic activity of one bacterial species can. provide an environment for enhanced growth of another bacterial species. This symbiosis is thought to occur in the organization of bacteria in the gingival sullcus. Oxygen requiring aerobic bacteria are predominately found at the free gingival margin. Deeper in the pocket, facultative bacteria capable of surviving in varying oxygen levels survive. At the depth of the pocket, strict anerobic bacteria are found. Thus, oxygen is removed by the aerobic and facultative bacteria, providing the environment required for growth of the strict anerobic bacteria. Similarly, microenvironments with radically different pH and metabolic concentrations allowing for preferential growth of bacteria with fastidious growth requirements.
Biofilms are thought to provide additional resistance to the usual host defenses and antibiotics/antimicrobial agents. Thus, bacteria within the sulcus that are embedded in secreted extracellular material making up the biofilm have significantly reduced contact with antibodies, complement and host defense cells. Further, the extracellular material making up the matrix of the biofilm impedes exposure of the bacteria to antibiotics explaining the limited results we have seen with periodontal treatment in Houston, Texas using these agents.
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