[Microbial aspects of periodontopathies and implications for antimicrobial treatment]

The development of periodontitis is always preceded by a gingivitis. Therefore, the studies of the etiological, histopathological, microbiological and therapeutic aspects of gingivitis form an essential contribution to the prevention of the major oral diseases. After 9-21 days without oral hygiene, in a previously healthy gingiva, a generalized mild gingivitis always develops. However, subclinical inflammation starts much earlier, obviously as a host reaction to the initial phases of plaque development. The development of gingivitis, and especially of peridontitis, is accompanied by a marked increase of anaerobic Gram-negative organisms and a decrease of aerobic Gram-positive organisms. However, their possible specific etiological role in the development of gingival inflammation is still unknown. On the other hand, the proliferation of the total mass of the original flora could be of importance, too. The actual treatment modalities of periodontal disease consist in a total non-specific elimination of the plaque, which imposes an intensive plaque control, independent of the individual tolerance level. Future bacteriological investigation will have to elucidate the pathogenic potential of specific micro-organisms.