TLRs played a significant role in initiating early periodontitis and promoting its advancement, and the levels of TLR4 expression exhibit a marked increase in gingivitis and various periodontal tissues including pocket epithelium, spinous epithelial layer, gingival fibroblasts, periodontal ligament fibroblasts, and connective tissues [45, 46]. This evidence concerns the gene TLR4 and periodontitis.