Presented by

Dr. Priyanka Singh

MDS-IInd year,
Department of Oral Pathology,
SPIDMS.
 CONTENTS
Introduction
Prokaryotic cell & eukaryotic cell
Bacteria
Staining of bacteria
Anatomy of bacteria
Growth and multiplication of bacteria
Growth regulation
Flora of the oral cavity
Dental plaque bio film
Calculus formation
Role of oral flora in systemic infection
Conclusion
 Introduction
Human beings like other animals, harbour a wide array of
microorganisms either on or in their bodies. A knowledge of
normal flora of body is essential to an understanding of the
interaction between human beings and their pathogen laden
environment.

The oral cavity is accessible to the introduction of many

different types of microorganisms and consist of large number
of microorganisms including mycoplasma, fungi, protozoa nad
viruses.
 Microorganisms

A heterogeneous group of several distinct classes of

living beings
Originally classified under plant and animal kingdoms
3rd kingdom protista was formed for them
Kingdom protista
Prokaryotes bacteria and blue-green algae
Eukaryotes fungi, algae, slime moulds and protozoa
 Prokaryotic cell & eukaryotic cell

Characteristic Prokaryote Eukaryote

Nucleus Absent Present

Diameter of cell About 1m 10-100m

Cytoskeleton Absent Present

Cytoplasmic organelle Absent Present

DNA content Unorganized Organized

Chromosomes Single circular Multiple linear

DNA molecule DNA molecule
 BACTERIA

Prokaryotic microorganisms

Do not contain chlorophyll

Unicellular

Do not show true branching except in Actinomycetes

 Staining of bacteria

Live bacteria do not show much structural detail due to

lack of contrast
Stained to produce colour contrast
Depending upon the effect of stains on the viability of
microorganisms
Supravital staining
Toxic
Kill the cells
Intravital staining
Nontoxic
Cells remain viable
Routine methods
Simple stain
Methylene blue & basic fuchsin
Do not stain bacterial capsules
Imparts same colour to all bacteria

Negative stain
India ink or nigrosin
Uniformly colors background
Unstained bacteria in contrast
Useful for demonstration of bacterial capsules
Spirochetes which are very slender can be stained
 Impregnation
Thin cellular structures can be seen
Thickened by impregnation of silver on the surface
Spirochetes and bacterial flagella

Differential stains
Imparts different colour to different bacteria or
bacterial structures
2 most widely used differential stains are
Gram stain
Acid fast stains
GRAMS STAIN
Devised by Christian Gram (1884)

Procedure
Primary staining with pararosaniline dye
e.g. crystal violet, methyl violet or gentian violet
Dilute solution of iodine
Decolorisation with an organic solvent e.g.- ethanol,
acetone or aniline
Counterstaining with a dye of contrasting colour
e.g. carbol fuchsin, Safranin or neutral red
Purpose of gram stain
Identification of bacteria
Therapy of bacterial infections - gram +ve bacteria are
more susceptible to penicillins
 Principle
GRAM +ve

Relates to the permeability of the bacterial cell wall and

cytoplasmic membrane to the dye
Gram ve cells permits the outflow of the dye during
decolorisation
Gram positive cells resist decolorisation and also has got a
more acidic protoplasm and so retain the primary stain,
appearing violet
Gram ve bacteria are decolorised by organic solvents and so
take the counter stain, appearing red

GRAM -ve
ACID FAST STAIN
Discovered by Ehrlich after staining with aniline dyes
tubercle bacilli resist decolorisation with acids
Modified by Ziehl and Neelson
Smear stained with carbol fuchsin with application
of heat
Decolorised with 20 % sulphuric acid
Counterstained with a contrasting dye
i.e. methylene blue
Acid fast bacteria retain fuchsin (red) colour while
others take the counter stain
 SIZE OF BACTERIA

0.2 1.5 m in diameter

3 5 m in length

SHAPE OF BACTERIA -
Cocci (kokkos berry) -
spherical or oval
Diplococci (in pairs)
Streptococci (in chains)
Grape like clusters
(staphylococci)
Bacilli (bacillus rod) rod shaped
Streptobacilli (in chains)
Corynebacteria (arranged at angles to
each other, presenting a cuneiform or
Chinese letter pattern)
Vibrios (comma shaped, curved rods)
characteristic vibratory motility
Spilrilla rigid spiral forms
Spirochetes (speira=coil ; chaite=hair)
flexuous spiral forms

Actinomycetes (actis = ray, mykes = fungus)

branching filamentous bacteria radiating
rays of the sun like appearance - due to
presence of rigid cell wall
Mycoplasma
Do not posses a stable morphology
protoplasts, spheroplasts or L-forms
Deficient cell wall due to drugs like
penicillin
Round or oval bodies

Some are pleomorphic

(pleo : many, morphic shaped)
 ANATOMY OF BACTERIA

Consists of

Outer layer or cell envelop

Cell wall
Plasma membrane

Inner cytoplasm and

cytoplasmic inclusions
Ribosomes and
Mesosomes
Granules
Vacuoles
Nuclear body
 Some bacterial cell
Enclosed by a viscid slimy
layer or organized as a
capsule

Filamentous appendages
protruding from the cell
surface flagella organs
of locomotion

Fimbriae organs of
locotion
STRUCTURES EXTERNAL TO CELL WALL
Flagella
Whip like long filaments
Used for locomotion
Guide the bacteria towards
nutritional and other sources
Composed of subunits of a
single protein flagellin
3 parts
Filament
Hook
Basal body
3-20 m long
0.01-0.013 m in diameter
 Flagella of different bacteria have same chemical composition
but are antigenically different

Flagellar antigens induce specific antibody in high titers

Flagellar antibodies are useful in serodiagnosis

Flagella
Peritrichos
Polar
Monotrichos
Lophotrichos
Amphitrichos
 Presence is usually detected by
motility of bacteria

Motility spreading type of

growth on a semisolid agar
medium

Present in all motile bacteria

except in spirochetes (move with
axial filament a flagellum like
structure)
Fimbriae & Pili
Fine hair like surface
appendages
Shorter than flagella
0.5 m long and 10 nm
thick
Present mainly on
gram ve bacteria
 Consists of self aggregating monomers of pilin

Adhesion of bacteria to receptors on human cell

surface first step in initiation of infection

Cause hemagglutination a method of detection

Antigenic in nature
Sex pili
A specialized type of fimbriae
Forms attachment between male
(donor) and the female
(recipient) through conjugation
tube
Genetic material is transferred
from donor to recipient cell
Glycocalyx (slime layer)

Loose undemarcated

Polysaccharide or
polypeptide covering

Adhesion of bacteria to
structures like oral mucosa,
teeth, etc.

E.g. - leuconostoc
 Capsule

An amorphous gelatinous layer

Surrounds entire bacteria

Composed of mainly polysaccharides

Antigenic

Demonstrable by serological methods

by antigenic differences of sugar
in polysaccharide capsule
 Mediates adhesion of bacteria to human tissues

Hinders or inhibits phagocytosis

Quelling reaction
Described by Neufeld (1902)
Presence of antiserum against capsular polysaccharide,
swelling of the capsule
Protects the bacteria from deleterious agents in nature.
Helps in virulence of pathogenic bacteria
Inhibits phagocytosis
E.g. streptococcus mutans
 Spores

E.g. bacillus & clostridium

Highly resistant resting stages

One bacteria forms one spore

on germination forms one
vegetative cell

Not a method of reproduction

Called endospores as are formed

inside the parent cell
 Cause in response to adverse conditions

Contains bacterial DNA, cytoplasm, cell membrane,

peptidoglycan, water and a thick, keratin like coat
Consists of calcium dipicolinate
Resistant to heat, dehydration, chemicals

Metabolically inert

Remain dormant for many years

Types of spores
Central, budging
Central, not budging
Sub terminal, budging
Sub terminal, not budging
Terminal, budging
Terminal, not budging
 When spores are transferred to favorable conditions
Spore loses its refractility
Swells
Spore wall is shed
Germ cell appears
Elongates to form vegetative bacterium
 Can be destroyed by autoclaving at 120 for 15 mins

Bacillus stearothermophilus ensures sterilization efficacy of

autoclaves

Appears unattained in gram stain

Can be stained by Ziehl-Neelson stain due to its acid fast

nature
 Cell wall

Confers rigidity upon

bacterial cell

Multilayered structure outside

protoplasmic membrane

Porous and semi permeable

Important in virulence and

immunity
 Demonstrable by plasmolysis

Hypertonic solution
Osmosis
Cytoplasm loses water
Shrinkage of cell
But cell wall retains its original shape
 Inner layer
Peptidoglycan
Scaffoldings formed by N-
acetyl glucosamine and N-
acetyl muramic acid
Present in chains which are
cross-linked by peptide
chains

Outer layer
Depends upon gram staining
property of bacteria
 Bacteria with deficient or defective cell walls

Mycoplasma

Do not posses cell wall

May cause human disease
e.g. pneumonia
L - forms
E.g. streptobacillus moniliformis
Swollen cells
Named after Lister Institute, London
Develops
Spontaneously
Presence of penicillin
Other agents that interfere with
cell wall synthesis
Cause urinary and suppurative
infections
Spheroplasts (gram ve bacteria) & protoplasts (gram +ve bacteria)

Lack cell walls

Cannot replicate on laboratory media
Unstable
Osmotically fragile
Require hypertonic conditions for
maintenance
Produced in laboratory by action of
enzymes or antibiotics

Spheroplast Protoplast
Conversion of bacteria into protoplast and spheroplast
 Cytoplasmic membrane

Thin inner layer lining the inner

surface of the cell wall
5 10 nm thick
Separates cell wall from cytoplasm
Semi permeable membrane
Passage through the membrane depends
upon-
Molecular size of the particles
Presence of specific enzymes
(permeases)
Consists of
Lipoprotein with small amounts of
carbohydrate
Sterols are absent except in mycoplasma
 Cytoplasm

Colloidal system of organic and

inorganic solutes in a viscous watery
solution

Differs from eukaryotic cytoplasm

Absence of protoplasmic streaming
Absence of endoplasmic reticulum and
mitochondria
Stains uniformly with basic dyes
Contains ribosome, mesosome,
inclusions (volutin granules or Babes
Ernst granules) and vacuoles,
metabolites and various ions
 Ribosomes

Centers of protein synthesis

Smaller than in eukaryotes

Sedimentation rate 70 s

Integrated in linear strands of mRNA to form

polysomes
 Mesosomes (chondroids)

Convoluted or multilaminated structures

Invaginations of plasma membrane into
the cytoplasm
More prominent in gram + ve bacteria
Principal site of respiration
Analogous top mitochondria of eukaryotes
 Nucleus

Demonstrated by acid or
ribonuclease hydrolysis
and subsequent staining
Oval or elongated
No nuclear membrane or
nucleolus
Genome consists of a single
molecule of double
stranded DNA arranged in a
form of a circle
Chromosome is haploid and
replicates by simple
binary fission
Plasmids or episomes

Extra nuclear genetic material

Carried by some bacteria

Consists of DNA

Cytoplasmic carriers of
genetic information
 GROWTH AND MULTIPLICATION
OF BACTERIA

Divide by binary fission

On reaching certain size
Nucleus divides
Cell divides to form 2 daughter cells
Generation time or population doubling time time interval
between two cell divisions generally vary from 20 mins
in E. coli to 24 hrs in M. tuberculosis
Can be arrested by
deficiency of nutrients
Accumulation of toxins
Antibiotics like penicillin and acriflavin
Bacterial growth curve
 Growth regulation

Regulated by nutritional environment

Intracellular
Extracellular

Intracellular
End-product inhibition first enzyme in metabolic
pathway is inhibited by end product of that pathway
Catabolic repression enzyme synthesis is inhibited by
catabolites
 Extracellular factors

Temperature
Can grow in a wide range of temperature
Mesophiles 25 40 C majority of bacteria
Thermophiles 55 80 C
Psychrophiles below 20 C

pH
Optimal growth at physiological pH 7.2 7.4
Vibrio cholera high degrees of alkalinity
 Oxygen requirement
Obligate aerobes require oxygen ATP generating
system is oxygen dependent e.g.-M. tuberculosis

Facultative anaerobes can survive in the absence

of oxygen - e.g.- Strep. Mutans & E. coli

Obligate anaerobes do not require oxygen -

e.g. Porphyromonas gingivalis

Microaerophiles grow best at low oxygen concentration

e.g. Campylobacter fetus
 Light -
Grows well in absence of light
Sensitive to ultraviolet and other radiations

Osmotic effect
More tolerant to osmotic variation
Due to mechanical strength of the cell walls
Sudden exposure to hypertonic solutions plasmolysis
mostly in gram ve bacteria
Plasmoptysis sudden transfer from conc. Solution to
distilled water swelling and rupture of cell
 Moisture and drying
Moisture is essential
Drying lethal
Highly sensitive for drying Treponema palladium

Antimicrobial therapy
Broad-spectrum antibiotics
Wipe out most of the endogenous flora
Favor fungal infection
 FLORA OF THE ORAL CAVITY

Gram positive cocci

Streptococcus
Gram positive
Non motile, flagella usually absent
Occur in chains
Generally non capsulated
Facultative anaerobes
Causes haemolysis
Selective medium mitis salivarius agar
Various types are
Mutans group
High, convex, opaque colonies
Produce extra cellular polysaccharide
Site tooth surfaces
Causes Dental caries
 Salivarious group

Appear in mouth of infants as early as 18 hrs to 1 month after birth.

Large mucoid colonies
Produce extra cellular fructans (polymer of fructose with a levan
structure)
Site dorsum of tongue and saliva (especially in infants)
Not a major oral pathogen

Mitis group

Small, rubbery or non adherent colonies

Site tongue and cheeks
Causes Dental plaque bio films, Dental caries, Infective
endocarditis
 Anaerobic streptococci

Strict anaerobes
Slow growing
Usually non hemolytic
Site teeth (carious dentin)
Causes Periodontal or Dentoalveolar abscess

Gram positive rods and cocci

Actinomyces

Strict and facultative anaerobes

Branched sun ray appearance
Ferments glucose characteristic patterns of short chain
carboxylic acids
Causes Dental caries (especially root caries) &
Gingivitis
Actinomycosis
 Lactobacillus
Micro-aerophiic
Aciduric (optimal ph=5.5-5.8)
Selective medium Rogosa agar
Catalase negative
Site common oral inhabitats
Causes Dental plaque bio film
Advancing front of dental caries

Eubacterium
Pleomorphic
Obligatory anaerobes
Site plaque bio films and calculus
Causes Role in dental caries
 Propionibacterium

Strict anaerobe
Produces propionic acid from glucose
Causes Root surface caries and Dento-alveolar infections

Gram negative cocci

Neisseria

Facultative anaerobe
Site tongue, oral mucosa, saliva and early plaque
Causes - not a major oral pathogen

Veillonela

Strict anaerobe
Site tongue, saliva and plaque bio film
 Gram negative rods
(Facultative anaerobe an capnophilic genera)
Hemophilus

Growth on heated blood agar

Requires X (haemin) and V (NAD) for growth
Site - oral mucosa, saliva and plaque bio film
Causes Dentoalveolar infections,
Acute sialadenitis
Infective endocarditis

Actinobacillus

Produces virulent factors leucotoxin, epitheiotoxin,

cardotoxin
Site periodontal pockets
Causes - Periodontal disease
 Gram negative rods (obligate anaerobic genera)
Produce brown black pigment on blood agar
Black pigmented anaerobes

Prevotella
Pleomorphic rods
Non-motile
Strict anaerobe
Require Vit. K and haemin for growth
Site gingival crevice and sub gingival plaque
Causes Chronic periodontitis and Dentoalveolar abscess

Fusobacterium
Sender, cigar shaped Gm ve rods with rounded ends
Site gingival crevice and tonsils
Causes periodontal infections
acute ulcerative gingivitis
dentoalveolar abscess
 Treponema

Motile
Helical cells (large, medium, small)
Strict anaerobes
Require enriched media with serum to grow
Site gingival crevice
Causes - acute ulcerative gingivitis
destructive periodontal disease
Other bacterial genus present are
Angiogenous group
Stomatococcus group
Propionibacterium group
Actinobacillus group
Eikenella group
Capnocytophaga group
Leptotrichia group
Wolinella
 Fungi and protozoa present in the oral cavity are
Fungi
Candida albicans
Candida tropicalis
Candida pseudo tropicalis
Cryptococcus

Protozoa -
Entameoba gingivalis
Factors in the oral cavity affecting growth
of micro flora
Anatomical factors -
Shape of teeth
Malalignment of teeth
Poor quality of restorations
Non-keratinized sulcular
epithelium

Difficult to clean

Favors accumulation of bacteria

 Saliva
Consist of proteins, glycoproteins and various other ions
& metabolites
Modulate bacterial growth by
Adsorption on the tooth surfaces pellicle facilitates
bacterial adhesion
Acts as a primary source of nutrition
Helps in aggregation of bacteria plaque formation
Inhibits growth -
Due to presence of defense factors
Lysozyme, lactoferrin, IgA, etc
Bactericidal and fungicidal
 Gingival crevicular fluid
Continuous but slow flow
Flushes microbes out of the crevice
Maintains pH level
Provide defense factors IgG ( also IgM & IgA)
Causes phagocytosis due to presence of neutrophils
 Microbial factors
Interaction of bacteria with each other may promote or
suppress the neighboring bacteria by
Competition for receptors for adhesion
Production of toxins by one may destroy same or other
bacterial species
Production of metabolic end products lowering of pH
Co-aggregation to form corn-cob formation with
Same (homotypic) or
Different (heterotypic) species
 Distribution of oral flora
Oral micro flora does not represent a homogenous collection
of organisms through out the oral cavity but it is localized in 3
different foci
Gingival crevices
Dorsum of tongue
Areas that are not cleaned by mastication
Other areas that may be involved are
Lips
Palate
Saliva
Cheeks or buccal mucosa
 Gingival crevices
The gingival crevice is not sterile, but harbors a microbial
flora in both health and disease

In healthy sulci, gram positive cocci are major macrophyte

and compose almost 2/3rd of total flora. Filamentous forms
and all spirochetes fusiforms are found.

In diseased conditions, gram positive as well a sgram

negative rods such as capnocytophaga, bacteroids,
compylobacter, fusobacterium can be isolated.
 Tongue
The tongue with its complex surface structures (crypts and
papilla) forms large surface areas that support growth of a
wide variety of bacteria and serves as a reservior of
microorganisms in the mouths.

Predominant cultivative bacteria isolated from the tongue

falls in the following list of microorganisms which are -
 Facultative streptococci
Veillonelle
Facultative diptheroids
Anaerobic diptheroids
Bacteroides
Peptostreptococcus
Neisseria
Vibrio
Fusobacterium
Provetella intermedia
Provetella melanogenicus
 Lips
The lips form the border between the skin flora and
consists predominantly of staphylococcus.
Facultative anaerobic micro flora comprises a large part of
flora of the lips.

Veillonella and neisseria have been found

If commissures are moistened by saliva, then Candida

albicans, Staph. aureus and Strept. Pyogenes are common.
 Cheeks/buccal mucosa
Predominant bacteria are Strept. sanguis and Strept.
salivarious.

Yeasts may also be isolated from carriers. Other organisms

may be hemophilus and neisseria sp.
 Palate
Hard palate supports a streptococcal flora resembling the
cheek flora

Haemophillus and lactobacilli are also found regularly

Yeasts and lactobacilli are increased dramatically, in some

denture wearers and flora may alter substantially when the
palate is protected from the action of tongue and saliva by
denture base.

Soft palate also harbor respiratory tract bacteria like

hemophilus, corynebacterium, neisseria.
 Saliva
Adult human saliva contains approx. 6 billion micro flora and
include
Streptococci
Peptostreptococci
Veillonella
Corynebacteria
Neisseria
Nocardia
Fusobacteria
Lactobacilli
Actinomycosis
Spirochetes
Fungi like Candida and Cryptococci
 Teeth
On eruption, teeth are covered by organic structure of embryonic
origin.

After eruption, organic deposits form on the surfaces of teeth which

contain organic acids, bacterial and cytotoxic agents.

Williams demonstrated microscopically, the presence of thick mass of

microorganisms covering the surface of teeth

G.V. Black introduced the term gelatinous microbial plaque to describe

microbial colonies on the surface of teeth.

Microorganisms do not attach themselves directly to mineralized tooth

surface as teeth are covered by teeth by an acellular proteinaceous film.
 DENTAL PLAQUE BIOFILM

Dental plaque is a tenacious microbial community which

develops on soft and hard surfaces of mouth, comprising of
living, dead and drying bacteria and their extra cellular
products, together with host compounds mainly derived from
saliva.
Composition
Organisms surrounded by organic matrix 30%
Matrix acts as a food reserve for adhesion of further bacteria
Composition varies
At different sites on same tooth
At same site on different teeth
At different time on the same tooth site
Distribution
Found on dental surfaces
and appliances
Mainly in absence of oral
hygiene
May be -
Supra gingival mainly
aerobic bacteria
Sub gingival mainly
anaerobic bacteria
 Plaque has been found to contain the following microorganisms in
percentages

Supragingival plaque -
Facultative streptococcus 87%
Facultative diphtheroids 23%
Anaerobic diphtheroids 18%
Peptostreptococcus 13%

Subgingival plaque -
Veillonella 6%
Bacteroids 4%
Fusobacteria 4%
Neisseria 3%
Vibrio 2%
 Stages of Plaque Bio film formation

Pellicle formation
Thin layer of salivary glycoproteins
Deposited on the surface
Forms within minutes of exposure to the oral
environment
Oral bacteria attach to pellicle for the initiation of plaque
formation
Transport
Bacteria are transported to pellicle site by
Natural salivary flow
Brownian motion
Chemo taxis
Long range interactions
Between microbial cell surface and pellicle coated tooth
Called pioneer group-gram positive cocci and rods
Through Vander waals forces
Reversible
Short range interactions
Polymer bridging between organisms and the surface
After which organisms come and accumulate to
increase the microorganism mass
Forms corn-cob arrangements
Secondary invaders - gram negative cocci and rods and
later by fusobacteria, spirals, and spirochetes
Irreversible
Co-aggregation or co-adhesion
Fresh Bacteria now attach to the primary invaders
May be of same genus or different genera
Process of plaque bio film mass reaches a critical size at
which
Deposition = Loss of bacterial accumulation
Climax community
The bacteria in climax community- detached
Plank tonic phase suspended in saliva transported to
new colonization site
 Bio film formation

Due to resultant confluent growth

Matures in complexity as time progresses
Occurs at inert surfaces e.g.- tooth enamel, dentures, etc.
Organisms may be arranged in columns or mushroom
shaped structures
Water channels that carry metabolites and nutrition are
interspersed within the organic matrix
 A bio film is defined as a complex functional community
of one or more species of microbes encased in and
exopolysachharide matrix and attached to one another or to
solid surface

Major component of bio film is extra-cellular matrix

Microbial polysaccharides
Salivary glycoproteins
 Calculus formation
Due to deposition of calcium and phosphate ions from saliva
within dental plaque

Bacteria in plaque as seeding agents of mineralization

Accelerated by bacterial phosphatases and proteases degrade

calcification inhibitors (Statherin and proline rich proteins) in
saliva
 Formation of insoluble calcium phosphate crystals

Coalesce to form a calcified mass of plaque calculus

Mature calculus
Mineralized material 80%
Organic compounds 20%
 Structure of calculus

Predominant flora cocci, bacilli, and filaments outer layers

Supra gingival calculus gram positive bacteria

Sub gingival gram negative bacteria

Outer surfaces of calculus

cocci attach

grow on surface of filamentous microorganism

corn cob arrangements

 Filaments orient themselves at right
angles to enamel surface Palisade
effect (like books on a shelf)
Cytoplasm of bacteria is
Reduced
Contains glycogens like food
storage granules
Ready source of nutrition during
periods of adversity
Has enough surface
Porous
Ideal reservoir for bacterial toxins
harmful to periodontium
 Role of oral flora in systemic infection

Plaque related oral diseases, especially periodontitis may alter

Cardiovascular disease
Infective endocarditis
Coronary heart disease
Bacterial pneumonia
Diabetes mellitus
Low birth weight babies
 According to focal infection theory
3 mechanisms lining oral infections to secondary systemic disease
are

1. Metastatic infection
Gain entry into vascular system through breach in oral vascular
barrier
E.g. - bacteraemias during tooth extractions

2. Metastatic injury
Products of bacteria (catalytic enzymes, endotoxins, exotoxins)
gain access to cardiovascular system

3. Metastatic inflammation
Caused by immunological injury due to antigens produced by
oral organisms enter blood stream from oral route - react with
circulating antibodies - immune mediated disease
 Factors for periodontitis predispose risk for systemic disease

Sub gingival bio films reservoir for gram ve bacteria

continuous source of lipopolysachharides (endotoxin) causes
Induction of major vascular responses
Up regulates endothelial cell adhesion molecules
Secretion of interleukin-1 and tumour necrosis factor-
Gain entry into vascular system
 Although, there are various controversies regarding
exact roe of oral flora in dental health, it can definitely be
stated that good oral health is important not only to
prevent oral disease but also to maintain good general
health.