Immunomicrobial pathogenesis of periodontitis: keystones, pathobionts, and host response

Trends Immunol. 2014 Jan;35(1):3-11. doi: 10.1016/ Epub 2013 Oct 23.


Recent studies have uncovered novel mechanisms underlying the breakdown of periodontal host-microbe homeostasis, which can precipitate dysbiosis and periodontitis in susceptible hosts. Dysbiotic microbial communities of keystone pathogens and pathobionts are thought to exhibit synergistic virulence whereby not only can they endure the host response but can also thrive by exploiting tissue-destructive inflammation, which fuels a self-feeding cycle of escalating dysbiosis and inflammatory bone loss, potentially leading to tooth loss and systemic complications. Here, I discuss new paradigms in our understanding of periodontitis, which may shed light into other polymicrobial inflammatory disorders. In addition, I highlight gaps in knowledge required for an integrated picture of the interplay between microbes and innate and adaptive immune elements that initiate and propagate chronic periodontal inflammation.

Keywords: dysbiosis; inflammation; keystone pathogen; pathobiont; periodontitis.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Alveolar Bone Loss
  • Cell Communication / immunology
  • Disease Susceptibility / immunology
  • Host-Pathogen Interactions
  • Humans
  • Inflammation / immunology
  • Inflammation / microbiology
  • Periodontitis / immunology*
  • Periodontitis / microbiology*
  • Periodontitis / therapy