Etiology and Risk Factors

Proposed Schedule

Part I (weeks 1-2)

Fundamentals of bacterial adherence, colonization, and invasion.

This series of lectures would center on the formation of dental plaque, ecology of supragingival, subgingival, root surface, and pit and fissure plaque formation.

Part II (weeks 3-4)

Pathways of microbial infection

This series of topics would first center on the pathways of infection into hard dental tissues (enamel demineralization/mineralization, dentin tubule invasion, pathways and defenses for microbial invasion into the pulp) followed by a similar series of lectures on pathways of microbial invasion into periodontal soft and hard tissues ( role and breakdown of protective barriers, direct microbial invasion, penetration of bacterial enzymes and endotoxins)

Part III (weeks 5-7)

Role of the host response in periodontal, carious and pulpal infection

I would first envision 4 lectures devoted to the host response in periodontal diseases using the newly developed "Critical Path" model to tie this rather complex topic together. By using this "Critical Path" model each lecture would be devoted to each sequential segment and would include:

a. the first line of defense (neutrophils, complement local humoral and secretory antibodies) and the bacterial virulence factors which overcome these defenses.

 b. The lymphocyte monocyte axis of the host defense: protective and destructive roles with emphasis of the difference of monocyte/lymphocyte-derived regenerative vs. inflammatory of cytokines and growth factors.

This lectures would be followed by 2 lectures on the similarities and differences of host response to caries (secretory antibodies) and the pulp (e.g. inflammation in a low compliance system and origins of pulpal pain).

 Part IV (Weeks 8-10)

 Basic systemic and local modifiers of caries, periodontal diseases, and pulpal diseases

A series of integrated lectures on the role of common modifiers including:

a. effects of non physiologic mechanical forces on oral tissues: effects of torque on cervical enamel; remodeling of periodontal tissues in controlled tooth movement; effects of increasing magnitudes of occlusal trauma on the tooth, periodontium, and pulp. (one week)

b. Effects of major systemic factors on dental diseases. There is obviously a lot of material that could be presented in this section. I would envision that we would concentrate on a few of the major topics and reinforce these and other systemic risk factors in second and third year courses.

For now I would concentrate on the role of:

  1. basic influences of aging
  2. immunosupressive diseases
  3. smoking/diabetes
  4. diet/ effects of reduced salivary flow
(one lecture each over two weeks)

Part V (week 11)


a necessary week in this course as we would, at the end of week 10, be at the end of DI Spring and would have a summer break.

Part VI (weeks 12-14)

Fundamentals of Dental Diagnosis and Risk Assessment for Dental Diseases.

A series of integrated topics focusing how various diagnostic and risk assessment and approaches can be used for the major dental disease of microbial origin. I would envision one week each devoted to the following topics.

  1. What we can learn form the oral fluids (saliva, and gingival crevicular fluid) including assessment of bacterial and host enzyme activity, microbial profiles, and microbial products.
  2. Assessing genetic predisposition to dental diseases.
  3. The role of stress in dental diseases. Physiological and psychological assessment of patients at risk
  4. Introduction to the mutual interactions between oral and systemic diseases.  Role of the systemic spread of oral microbiota and oral inflammatory mediators in cardiovascular diseases, organ system infection, low birthweight etc.  Effects of loss of masticatory function from dental diseases on overall health.
Last Webpage Update: 6/27/13

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