Elsevier

The Lancet

Volume 366, Issue 9499, 19–25 November 2005, Pages 1809-1820
The Lancet

Seminar
Periodontal diseases

https://doi.org/10.1016/S0140-6736(05)67728-8Get rights and content

Summary

The periodontal diseases are highly prevalent and can affect up to 90% of the worldwide population. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm (dental plaque) that accumulates on teeth adjacent to the gingiva (gums). However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition to pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Genetic, dermatological, haematological, granulomatous, immunosuppressive, and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes, but the causal relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease, and restoring lost tooth support.

Section snippets

Oral microorganisms

The mouth, like all external surfaces of the body and the gut, has a substantial microflora living in symbiosis with a healthy host. The microflora of the mouth contains hundreds of species of aerobic and anaerobic bacteria. These organisms grow on tooth surfaces as complex, mixed, interdependent colonies in biofilms, and are attached and densely packed against the tooth in the deeper layers, with more motile forms in the superficial layers.9 Cultural studies indicate that more than 500

Pathogenesis

Although bacteria are necessary for periodontal disease to take place, a susceptible host is also needed. The immune-inflammatory response that develops in the gingival and periodontal tissues in response to the chronic presence of plaque bacteria results in destruction of structural components of the periodontium leading, ultimately, to clinical signs of periodontitis. An individual's risk for periodontal disease could be linked to gingival inflammation (bleeding) in response to plaque

Clinical findings of chronic gingivitis and periodontitis

Chronic gingivitis often results in mild bleeding from the gums during tooth brushing, which is generally only a minor inconvenience unless underlying blood dyscrasias or bleeding disorders exist. Chronic periodontitis is usually asymptomatic until the disease is so severe that teeth shift, loosen, or are lost. Individuals with advanced periodontitis may also have recurrent periodontal abscesses and halitosis.

The clinical diagnosis of chronic periodontal disease is based on visual and

Periodontal manifestatons of systemic diseases

Various systemic diseases could be manifest in the periodontal tissues.2 These disorders include herpetic and other viral infections; dermatological conditions such as lichen planus, pemphigoid, and pemphigus; haematological diseases such as leukaemia and neutropenia (figure 3); granulomatous diseases such as tuberculosis and Wegener's granulomatosis (figure 4); and primary and metastatic carcinoma. Diagnosis of these atypical forms of disease is based on clinical as well as pertinent

Preterm birth

Several case-control or prospective cohort studies have reported a link between poor maternal periodontal health and risk for preterm birth, low birthweight, and pre-eclampsia.108, 109, 110, 111, 112 Although two large studies in the UK did not find such associations,113, 114 it is important to note that studies reporting a positive association of adverse pregnancy outcomes and maternal periodontal disease included predominantly African-Americans or Hispanic-Americans who were at higher risk

Prevention and treatment of chronic gingivitis and periodontitis

Prevention of gingivitis and periodontitis is based on the control of their causal and risk factors (as defined by an attribute that is causally related its pathogenesis). The most widely accepted risk factor is the periodontal biofilm that forms on the teeth in the absence of effective oral hygiene. However, various factors such as smoking, diabetes, ethnic origin, specific types of gram-negative anaerobic bacteria in the periodontal biofilm, poor education, infrequent dental attendance,

Research needs

There are many needs for additional research in periodontology, including the development of biomarkers of current and future disease activity. Effective community-based and population-based means of prevention need to be investigated, and although current treatments are generally quite effective in arresting disease progression and restoring some degree of lost periodontal support, further study is needed to develop and test innovative treatment strategies that are less invasive, more cost

Search strategy and selection criteria

The MEDLINE database was searched by use of PubMed to identify articles containing “periodontal”, as well as specific periodontal diseases and associated conditions, or causal or risk factors discussed in this Seminar. As additional sources and crosschecks for the reliability of the search strategy, we reviewed comprehensive textbooks on periodontology.

References (197)

  • M Ronderos et al.

    Periodontal disease among indigenous people in the Amazon rain forest

    J Clin Periodontol

    (2001)
  • JM Albandar et al.

    Destructive periodontal disease in adults 30 years of age and older in the United States, 1988–1994

    J Periodontol

    (1999)
  • MA Listgarten

    Structure of the microbial flora associated with periodontal health and disease in man. A light and electron microscopic study

    J Periodontol

    (1976)
  • WE Moore et al.

    The bacteria of periodontal diseases

    Periodontol 2000

    (1994)
  • I Kroes et al.

    Bacterial diversity within the human subgingival crevice

    Proc Natl Acad Sci USA

    (1999)
  • PW Lepp et al.

    Methanogenic Archaea and human periodontal disease

    Proc Natl Acad Sci USA

    (2004)
  • LA Ximenez-Fyvie et al.

    Comparison of the microbiota of supra- and subgingival plaque in health and periodontitis

    J Clin Periodontol

    (2000)
  • A Tanner et al.

    Microbiota of health, gingivitis, and initial periodontitis

    J Clin Periodontol

    (1998)
  • A Tanner et al.

    Clinical, microbiological and immunological profile of healthy, gingivitis and putative active periodontal subjects

    J Periodontal Res

    (1996)
  • P Ramberg et al.

    Bacterial colonization during de novo plaque formation

    J Clin Periodontol

    (2003)
  • SS Socransky et al.

    Microbiology of periodontal disease

  • NP Lang et al.

    Toothbrushing frequency as it relates to plaque development and gingival health

    J Periodontol

    (1973)
  • RG Watt et al.

    Does oral health promotion improve oral hygiene and gingival health?

    Periodontol 2000

    (2005)
  • SS Socransky et al.

    Subgingival microbial profiles in refractory periodontal disease

    J Clin Periodontol

    (2002)
  • M Sanz et al.

    Methods of detection of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythensis in periodontal microbiology, with special emphasis on advanced molecular techniques: a review

    J Clin Periodontol

    (2004)
  • SS Socransky et al.

    Microbial complexes in subgingival plaque

    J Clin Periodontol

    (1998)
  • SS Socransky et al.

    Evidence of bacterial etiology: a historical perspective

    Periodontol 2000

    (1994)
  • MG Newman et al.

    Studies of the microbiology of periodontosis

    J Periodontol

    (1976)
  • RL Mandell et al.

    A selective medium for Actinobacillus actinomycetemcomitans and the incidence of the organism in juvenile periodontitis

    J Periodontol

    (1981)
  • A Kubar et al.

    Real-time polymerase chain reaction quantification of human cytomegalovirus and Epstein-Barr virus in periodontal pockets and the adjacent gingiva of periodontitis lesions

    J Periodontal Res

    (2005)
  • BS Michalowicz et al.

    Human herpesviruses and Porphyromonas gingivalis are associated with juvenile periodontitis

    J Periodontol

    (2000)
  • J Slots

    Herpesviruses, the missing link between gingivitis and periodontitis?

    J Int Acad Periodontol

    (2004)
  • PG Robinson

    The significance and management of periodontal lesions in HIV infection

    Oral Dis

    (2002)
  • AD Haffajee et al.

    Subgingival microbiota of chronic periodontitis subjects from different geographic locations

    J Clin Periodontol

    (2004)
  • TE Van Dyke et al.

    Risk factors for periodontitis

    J Int Acad Periodontol

    (2005)
  • TC Hart et al.

    Mutations of the cathepsin C gene are responsible for Papillon-Lefevre syndrome

    J Med Genet

    (1999)
  • C Toomes et al.

    Loss-of-function mutations in the cathepsin C gene result in periodontal disease and palmoplantar keratosis

    Nat Genet

    (1999)
  • TC Hart et al.

    Haim-Munk syndrome and Papillon-Lefevre syndrome are allelic mutations in cathepsin C

    J Med Genet

    (2000)
  • C Hewitt et al.

    The role of cathepsin C in Papillon-Lefevre syndrome, prepubertal periodontitis, and aggressive periodontitis

    Hum Mutat

    (2004)
  • BS Michalowicz et al.

    Periodontal findings in adult twins

    J Periodontol

    (1991)
  • BS Michalowicz et al.

    A twin study of genetic variation in proportional radiographic alveolar bone height

    J Dent Res

    (1991)
  • BS Michalowicz et al.

    Evidence of a substantial genetic basis for risk of adult periodontitis

    J Periodontol

    (2000)
  • LA Corey et al.

    Self-reported periodontal disease in a Virginia twin population

    J Periodontol

    (1993)
  • KS Kornman et al.

    The interleukin-1 genotype as a severity factor in adult periodontal disease

    J Clin Periodontol

    (1997)
  • DF Kinane et al.

    Genes and gene polymorphisms associated with periodontal disease

    Crit Rev Oral Biol Med

    (2003)
  • G Greenstein et al.

    A critical assessment of interleukin-1 (IL-1) genotyping when used in a genetic susceptibility test for severe chronic periodontitis

    J Periodontol

    (2002)
  • J Bergstrom

    Tobacco smoking and chronic destructive periodontal disease

    Odontology

    (2004)
  • T Modeer et al.

    Relation between tobacco consumption and oral health in Swedish schoolchildren

    Acta Odontol Scand

    (1980)
  • GK Johnson et al.

    Impact of tobacco use on periodontal status

    J Dent Educ

    (2001)
  • PB Robertson et al.

    Periodontal effects associated with the use of smokeless tobacco

    J Periodontol

    (1990)
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