T. denticola dwells in a complex and diverse microbial community within the oral cavity and is highly specialized to survive in this environment.

The presence of the periplasmic flagella is widely regarded as being responsible for the microorganism's ability to rotate and flex, in addition to its translational movement.

These spirochetes attach to proteins (including fibronectin and collagen) of local gingival fibroblasts, binding to their plasma membrane.

Accumulation of T. denticola in this manner facilitates the disease-causing process, including membrane blebbing and red blood cell lysis.

[10] [11]Treponema denticola, a subgingival oral spirochete has been associated with many periodontal disease conditions such as: the early stage of periodontitis, acute pericoronitis (infection under the gum tissue covering a partially erupted tooth)3, as well as necrotising ulcerative gingivitis (severe inflammation of the gum more common in immunocompromised patients).

Treponema denticola attaches to fibroblasts and epithelial cells as well as to extracellular matrix components which are found in periodontal tissues and release its own bacterial contents.

The bacterial components are:[citation needed] A number of studies have observed an increase of T. denticola in patients with orthodontic appliances, particularly the fixed type.

[14]  The presence of T. denticola along with other periodontal pathogens and bacterial diversity within the oral cavity are important factors contributing to cancerous cells (including precancerous gastric lesions).