Background: Periodontitis is the inflammation of the tooth-supporting structures and is one of the most common diseases of the oral cavity. The outcome of periodontal infections is tooth loss due to a lack of alveolar bone support. Osteoclasts are giant, multi-nucleated, and bone-resorbing cells that are central for many osteolytic diseases, including periodontitis. Receptor activator of nuclear factor-kB ligand (RANKL) is the principal factor involved in osteoclast differentiation, activation, and survival. However, under pathological conditions, a variety of pro-inflammatory cytokines secreted by activated immune cells also contribute to osteoclast differentiation and activity. Lipopolysaccharide (LPS) is a vital component of the outer membrane of the Gram-negative bacteria. It binds to the Toll-like receptors (TLRs) expressed in many cells and elicits an immune response.

Highlights: The presence of bacterial LPS in the periodontal area stimulates the secretion of RANKL as well as other inflammatory mediators, activating the process of osteoclastogenesis. RANKL, either independently or synergistically with LPS, can regulate osteoclastogenesis, while LPS alone cannot. MicroRNA, IL-22, M1/M2 macrophages, and memory B cells have recently been shown to modulate osteoclastogenesis in periodontal diseases.

Conclusion: In this review, we summarize the mechanism of osteoclastogenesis accompanying periodontal diseases at the cellular level. We discuss a) the effects of LPS/TLR signaling and other cytokines on RANKL-dependent and -independent mechanisms involved in osteoclastogenesis; b) the recently identified role of several endogenous factors such as miRNA, IL-22, M1/M2 macrophages, and memory B cells in regulating osteoclastogenesis during periodontal pathogenesis.