Prof. Doina Onisei

Etiopathogenical aspects of periodontal disease

Etiological factors of periodontal disease are the factors who produce, modify or contribute to the aparition and evolution of periodontal destructions. The concept of etiology is important because both the prevention and the treatment of periodontal disease depend on the through understanding of the relationship between the etiological factors and the pathogenesis of periodontal disease.

The primary factor in the etiology of inflammatory periodontal disease is the accumulation and maturation of bacterial biofilm on the teeth,  near the gingival margin and/or in the sulcus or pocket.

The patient’s periodontal tissues response to the bacteria is influenced by local, immune and systemic resistance factors. In periodontal health, a balance exists between the pathogenity of the small amounts of bacterial plaque present on the teeth and the patient’s resistance. When gingivitis or periodontitis develops, an imbalance exists between the pathological effects of the microorganisms and the ability of the patient’s local, immune and systemic defence mechanisms.

Most commonly, the imbalance is related to an increase in the number or changes in the types of microorganisms present, but changes in the defence mechanisms also occure, that can upset the balance and allow pathological changes to develop with only minimal changes in the biofilm.

The local, immunological and systemic factors are definitely interconnected in that together they play a vital role in the etiology of periodontal diseases.

Four stages in the pathogenesis of inflammatory periodontal disease have been described :

• The initial lesion
• The early lesion
• The established lesion
• The advanced lesion