![]() ![]() “Keystone-Pathogen Hypothesis” in 2012 5 proposes that certain low-abundance microbial pathogens can cause inflammatory disease by interfering with the host immune system and remodeling the microbiota. The “Ecological Plaque Hypothesis” put forward by Marsh 4 in 1994, emphasized that periodontal disease is the result of an imbalance in the microflora by ecological stress resulting in an enrichment of certain disease-related micro-organisms. The “Specific Plaque Hypothesis”, which followed in 1976 concluded that only a few species of the total microflora are actively involved in disease taking into account differences in virulence among bacteria. The “Non-Specific Plaque Hypothesis” proposed by Black and Miller in the late 1800s, believed that the total microflora could lead to disease. It has gone through paradigm shifts of ideologies over the past century such as the non-specific/specific plaque hypotheses, the ecological plaque hypothesis and recently the PSD model. 2Īdvances in molecular research and the oral microbiome 3 study have depicted the number of oral bacteria (cultivable and not) to a mind-boggling 700 species! The subgingival biofilm is the primary etiology of periodontal disease initiation and progression and for this reason periodontal microbiology has been the focus of research over centuries. 1 Besides it’s local impact, periodontal infections are also associated with various far-reaching systemic effects, like diabetes mellitus and cardiovascular diseases. Periodontitis is a polymicrobial infection leading to chronic inflammation of the supporting structures of the teeth that leads to pocket formation and breakdown of alveolar bone around the teeth, resulting in tooth loss. Keywords: chronic periodontitis, keystone pathogens, polymicrobial synergy dysbiosis, gram positive anerobes, diabetes mellitus, cardiovascular diseases Abbreviations This mini review aims at a comprehensive analysis of the literature available on the association of GPA (Gram Positive Anaerobes) with various periodontal disease conditions. However, their absolute role in the same has not been clearly defined. Over the past decade, various studies have showed the association of GPA with periodontal disease conditions. Among these, the Gram-positive anaerobic bacteria are in the forefront. However, with the advent of open-ended molecular techniques such as 16s rRNA sequencing and cloning, organisms that were not considered pathogenic to periodontal infections are now emerging as possible contributors to the microbial etiology of periodontitis. Many Gram-negative anaerobic bacilli such as Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, were considered as keystone pathogens and a pre-requisite for periodontal disease activity and progression. The microbial etiology of periodontitis is defined by the sub gingival plaque biofilm in which resides an interdependent microbial community containing numerous species of bacteria. Periodontal diseases are a group of chronic inflammatory, polymicrobial infections, which result in gradual loss of tooth attachment to the bone and eventual loss of the tooth. ![]()
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