Behavioural risk factors absent
Behavioural risk factors present
Environmental risk factors absent
Environmental risk factors evident
Gingivitis
Clinical Health
Periodontitis
Antibody
Antibody
DAMPs Haem ↑ GCF
Complement
Connective tissue & bone damage
Proportionate host response
Incipient dysbiosis (quorum- sensing bacteria)
Frank dysbiosis (pathogenic biofilm)
Disproportionate host response (hyper- inflammatory)
PMNs ++
PMNs +++
Health- promoting biofilm = Symbiosis
Proportionate host response
PMNs
Plasma cells
T & B cells
Cytokines
Antigens
Chronic non- resolving inflammation
Antigens Gingipains LPS
Antigens Bact’l DNA fMLP
Failed resolution of inflammation
Virulence Factors
Prostanoids MMPs
High biomass
High biomass
Low biomass
Resolving inflammation
Non-resolving inflammation
LPS
Oxidative Stress
Genetic risk factors absent
Genetic risk factors present
Epigenetic effects not evident
Epigenetic effects evident
Chapple 2015
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