Section A · Opening
KIDS
Kalinga Institute of Dental Sciences
KIIT Deemed to be University · Bhubaneswar

Department of Periodontology & Oral Implantology

Etiopathogenesis
of Periodontal Disease

A Clinical Masterclass for Postgraduate Students

Dr. Debasish Mishra
Associate Professor · Dept. of Periodontology & Oral Implantology · KIDS, KIIT University
PG Masterclass Series
Why This Matters
1 in 5
adults worldwide has severe periodontitis
🌍
6th
Most prevalent disease globally — affecting over 1 billion people
⚖️
The Paradox
Some patients with heavy plaque never develop periodontitis. Why?
🔬
Invisible
The villain: 500+ microbial species organised into a living biofilm

Disease does not progress linearly. It reaches a tipping point — the moment host defences are overwhelmed and destruction begins. Understanding why that tipping point occurs is the entire story of etiopathogenesis.

The Framework

A Story of Five Characters

Each plays a distinct role in the unfolding drama of periodontal disease
The Villain
Dysbiotic Microbiome
Plaque biofilm · Keystone pathogens · Microbial dysbiosis
Villain's Arsenal
  • Dental plaque biofilm
  • Red complex pathogens
  • P. gingivalis — keystone
  • LPS & virulence factors
  • Quorum sensing signals
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The Victim
Host Periodontium
Gingiva · Alveolar bone · PDL · Immune defences
Victim's Vulnerability
  • Gingival epithelium
  • Innate immune response
  • Adaptive T & B cells
  • Alveolar bone integrity
  • Genetic susceptibility
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The Conflict
Pathogenesis
Inflammatory cascade · Cytokines · Tissue & bone destruction
The Battle
  • IL-1β, TNF-α, IL-6
  • MMP activation
  • RANKL / OPG axis
  • Alveolar bone loss
  • Periodontal pocket
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The Referee
Risk Modifiers
Genetics · Diabetes · Smoking · Stress · Systemic factors
Who Wins?
  • Genetic polymorphisms
  • Diabetes mellitus
  • Tobacco smoking
  • Psychosocial stress
  • Medications & age
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The Hero
The Periodontist
Gatekeeper · Enforcer · Systemic guardian
Superpowers
  • Early risk stratification
  • Biofilm disruption
  • Host modulation therapy
  • Systemic health guardian
  • Resolution medicine
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