The Immune System Is Essential For

The immune system is essential for the maintenance of periodontal health, and it is central to the host
response to periodontal pathogens. However, if the immune response is dysregulated, inappropriate,

persistent, or excessive in some way, then damaging chronic inflammatory responses such as those
observed in periodontal disease can ensue. The immune response to plaque bacteria involves the
integration at the molecular, cellular, and organ level of elements that are often categorized as being
part of the innate immune system or the adaptive immune system. Furthermore, host responses in
periodontal disease (and other major human diseases) were until recently represented as a linear
progression from the host's recognition of microbial pathogens, to innate immune responses dominated
by the action of phagocytic neutrophils, and culminating in the establishment of adaptive immune
responses led by antigen-specific effector functions (e.g., cytotoxic T cells, antibodies). It is now widely
appreciated that immune responses are complex biologic networks in which pathogen recognition,
innate immunity, and adaptive immunity are integrated and mutually dependent. This complex network
is flexible and dynamic, with aspects of positive and negative regulation, as well as feedback control;
signals are amplified and broadcast, which leads to diverse effector functions. Furthermore, the immune
system is integrated with other systems and processes, including the nervous system, hematopoiesis,
and hemostasis, as well as elements of tissue repair and regeneration.
Observational studies of periodontal tissues and investigations of animal models and cell and tissue
systems have allowed us to identify aspects of the immune response that are relevant to periodontitis.
Immune responses, which underpin periodontal disease, have unique facets that must be considered
before we can truly rationalize the detailed information that we have about individual immune cell
functions and their responses to specific periodontal pathogens. Thus we need to understand how the
polymicrobial biofilm (as opposed to individual species of periodontal pathogens) interacts with host
immune defenses. We also need to appreciate specific immunologic properties that relate to the unique
anatomy of the periodontium, to understand how immune responses contribute to the dynamic aspects
of periodontal disease and its various clinical courses, and to gain a comprehension of how elements of
host immunity contribute to tissue destruction, resolution, repair, and regeneration.
Observational studies of periodontal tissues and investigations of animal models and cell and tissue
systems have allowed us to identify aspects of the immune response that are relevant to periodontitis.
92,135 Immune responses, which underpin periodontal disease, have unique facets that must be
considered before we can truly rationalize the detailed information that we have about individual
immune cell functions and their responses to specific periodontal pathogens. Thus we need to
understand how the polymicrobial biofilm (as opposed to individual species of periodontal pathogens)
interacts with host immune defenses. We also need to appreciate specific immunologic properties that
relate to the unique anatomy of the periodontium, to understand how immune responses contribute to
the dynamic aspects of periodontal disease and its various clinical courses, and to gain a comprehension
of how elements of host immunity contribute to tissue destruction, resolution, repair, and regeneration.
Innate Immunity
Defenses against infection include a wide range of mechanical, chemical, and microbiologic barriers that
prevent pathogens from invading the cells and tissues of the body. Saliva, GCF, and the epithelial
keratinocytes of the oral mucosa all protect the underlying tissues of the oral cavity and the
periodontium. The commensal microbiota (e.g., in dental biofilm) may also be important for providing
protection against infection by pathogenic microorganisms through effective competition for resources
and ecologic niches and also by stimulating protective immune responses. The complex microanatomy
of the periodontium, including the diversity of specialized epithelial tissues, presents many interesting
challenges for the study of the immunopathogenesis of periodontal disease.
If bacterial products enter the tissues, then the cellular and molecular elements of the innate immune
response are activated. The term innate immunity refers to the elements of the immune response that
are determined by inherited factors (and therefore “innate”), that have limited specificity, and that are
“fixed” in that they do not change or improve during an immune response or as a result of previous
exposure to a pathogen. The recognition of pathogenic microorganisms and the recruitment of effector
cells (e.g., neutrophils) and molecules (e.g., the complement system) are central to effective innate
immunity. Innate immune responses are orchestrated by a broad range of cytokines, chemokines, and
cell surface receptors, and the stimulation of innate immunity leads to a state of inflammation. If innate
immune responses fail to eliminate infection, then the effector cells of adaptive immune responses
(lymphocytes) are activated. It is increasingly appreciated that the immune response functions as a
network of interacting molecular and cellular elements in which innate immunity and adaptive (antigen-
specific) immunity work together toward a common purpose. Aspects of innate immunity that are
relevant to periodontal disease are now considered.
Innate Immunity Adaptive Immunity

Refers to nonspecific defense mechanisms that Refers to antigen-specific immune responses.
act as barriers to infection. Components Components include:
include: • Recognition of specific molecules on infecting
• Barriers to infection such as skin, mucosa, organisms at the species and strain level
acid pH in the stomach • Cellular immune responses focused on
• Antimicrobial molecules such as lysozyme, defense from intracellular pathogens (e.g.,
antimicrobial peptides viruses), involving cytokines from T helper cells,
• Immune system cells such as neutrophils and macrophages, and natural killer cells
macrophages that kill infecting organisms • Humoral immune responses focused on
• Receptors (e.g., Toll-like receptors) that defense from extracellular pathogens (e.g.,
recognize pathogen-derived molecules and bacteria), involving B cells that differentiate into
activate immune– inflammatory responses antibodyproducing plasma cells
• Antigen presentation to activate adaptive
immune responses
Innate and adaptive immunity do not function in isolation; close integration exists between the innate
and adaptive arms of the immune response

The Immune System Is Essential For

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The immune system is essential for the maintenance of periodontal health, and it is central to the host

response to periodontal pathogens. However, if the immune response is dysregulated, inappropriate,

Innate Immunity Adaptive Immunity

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