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The Villain — Dysbiotic Microbiome

Act 1 · Microbial Complexes · Keystone Pathogen Hypothesis

1

Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr. Microbial complexes in subgingival plaque. J Clin Periodontol. 1998;25(2):134–44.

2

Hajishengallis G, Darveau RP, Curtis MA. The keystone-pathogen hypothesis. Nat Rev Microbiol. 2012;10(10):717–25.

3

Hajishengallis G, Liang S, Payne MA, Hashim A, Jotwani R, Eskan MA, et al. A low-abundance biofilm species orchestrates inflammatory periodontal disease through the commensal microbiota and complement. Cell Host Microbe. 2011;10(5):497–506.

4

Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30–44.

5

Darveau RP. Periodontium as a model for bacterial pathogenesis. Nat Rev Microbiol. 2010;8(9):577–88.

6

Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965;36:177–87.

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The Victim — Host Periodontium

Act 2 · Innate & Adaptive Immunity · Histological Stages

7

Page RC, Schroeder HE. Pathogenesis of inflammatory periodontal disease. A summary of current work. Lab Invest. 1976;34(3):235–49.

8

Garlet GP. Destructive and protective roles of cytokines in periodontitis: a re-appraisal from host defense and tissue destruction viewpoints. J Dent Res. 2010;89(12):1349–63.

9

Taubman MA, Kawai T. Involvement of T-lymphocytes in periodontal disease and in direct and indirect induction of bone resorption. Crit Rev Oral Biol Med. 2001;12(2):125–35.

⚔️

The Conflict — Pathogenesis

Act 3 · Cytokine Storm · MMPs · RANKL/OPG · Disease Models

10

Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction. Periodontol 2000. 1997;14:9–11.

11

Kornman KS, Page RC, Tonetti MS. The host response to the microbial challenge in periodontitis: assembling the players. Periodontol 2000. 1997;14:33–53.

12

Birkedal-Hansen H. Role of matrix metalloproteinases in human periodontal diseases. J Periodontol. 1993;64(5 Suppl):474–84.

13

Graves DT, Cochran D. The contribution of interleukin-1 and tumor necrosis factor to periodontal tissue destruction. J Periodontol. 2003;74(3):391–401.

14

Kornman KS. Mapping the pathogenesis of periodontitis: a new look. J Periodontol. 2008;79(8 Suppl):1560–8.

🏛️

The Referee — Risk Modifiers & Classification

Act 4 · 1999 AAP · 2017 World Workshop · Systemic Links

15

Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996;67(10 Suppl):1103–13.

16

Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6.

17

Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89 Suppl 1:S159–72.

18

Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89 Suppl 1:S173–82.

19

Genco RJ. Current view of risk factors for periodontal diseases. J Periodontol. 1996;67(10 Suppl):1041–9.

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The Hero — Treatment & Future

Act 5 · Treatment Cascade · Resolution Biology · Precision Periodontology

20

Van Dyke TE, Serhan CN. Resolution of inflammation: a new paradigm for the pathogenesis of periodontal diseases. J Dent Res. 2003;82(2):82–90.

21

Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, et al. Treatment of stage I–III periodontitis — the EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47 Suppl 22:4–60.

22

Offenbacher S. Periodontal diseases: pathogenesis. Ann Periodontol. 1996;1(1):821–78.