Pathogenesis

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Plaque forms on teeth at the gum margin, especially in hard to clean areas between the teeth. Calcium salts deposited in the plaque result in hard to remove dental calculus, often referred to as tartar. Plaque gradually extends into the gingival crevice and bacterial products incite an inflammatory and immune response manifested by swelling and redness of the gingiva (figure 24.5). This gum inflammation is known as gingivitis. If the plaque remains small, polymorphonuclear leukocytes along with cellular and humoral immunity limit the process at this stage. Large populations of microorganisms, however, release the enzymes collagenase and hyaluronidase, which weaken the gingival tissue and cause the gingival crevice to widen and deepen. As the plaque enlarges, the proportion of anaerobic Gram-negative bacteria such as Porphyromonas gingivalis increases. These organisms release endotoxin and a variety of exotoxins that attack leukocytes and host tissue, but they generally do not invade the tissues of the host. The membrane that attaches the root of the tooth to the bone weakens, and the bone surrounding the tooth gradually softens. The tooth becomes loose and may be lost.

24.3 Bacterial Diseases of the Upper Alimentary System

(a)

Figure 24.5 Periodontal Disease (a) Normal gingiva. (b) Periodontal disease, with plaque, inflammatory changes, bleeding, and shortening of the gingiva between the teeth.

Figure 24.5 Periodontal Disease (a) Normal gingiva. (b) Periodontal disease, with plaque, inflammatory changes, bleeding, and shortening of the gingiva between the teeth.

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