The Relationship Between Plaque Biofilm and Disease

Despite all the recent discoveries, particularly over the past 10 years, it still remains unclear as to how the microbes within plaque biofilm become dysbiotic and cause disease. There has been a lot of speculation about the temporality of events leading to periodontal disease and more specifically, which comes first, inflammation or dysbiosis of the polymicrobial biofilm? A new model has recently been proposed by Van Dyke and colleagues⁴ suggesting that initial inflammation caused by the host innate immune response attempting to maintain and/or restore homeostasis during health and gingivitis, is the first stage of the process. If attempts made by the host response are not successful in maintaining balance in the microbiome, then growth of pathobionts overcome the balance causing dysbiosis that ultimately leads to periodontitis.⁴ This new Model, now referred to as the “Inflammation-Mediated-Polymicrobial-Emergence and Dysbiotic-Exacerbation” (IMPEDE) model was designed by its authors as a subsequent follow-up to the 2017 World Workshop Classification of Periodontitis.⁴