Unit 5. Indirect/ Direct Mechanisms

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Direct:

- by products of plaque - direct damage of gingival tissue enable other bacterial by-products to enter and cause more damage - endotoxins: produced by dying gram - bacteria and lipopolysaccharides released from cell wall: stimulates TNF to trigger osteoclasts, and PGE2 to trigger osteoclasts and collagenase and activates complement cascade, Ig production and clotting - exotoxins: produced by living bacteria e.g fibrinolysin breaks down fibroblasts that form fibres and ground substance, epitheliotoxin 1st to destroy epithelium and allow others to enter, leucotoxin destroys monocytes, neutrophils and lymphocytes so no phagocytosis - enzymes: e.g protease only released from certain bacteria and destroys proteins and causes vasodilation, collagenase degrades collagen in ground substance and attached gingiva, hyaluronidase grades hyaluronic acid in ground substance and increases permeability of connective tissue - metabolic waste e.g volatile sulphur compounds causes reduction of oxygen levels and permeability of epithelium





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