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.
SeminarPeriodontal diseases
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
References (197)
- et al.
Gene polymorphisms in pro-inflammatory cytokines are associated with systemic inflammation in patients with severe periodontal infections
Cytokine
(2004) - et al.
Intraoral leukoplakia, abrasion, periodontal breakdown, and tooth loss in a snuff dipper
J Am Dent Assoc
(1979) - et al.
Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS
Oral Surg Oral Med Oral Pathol
(1994) - et al.
Changing prevalence of oral manifestations of human immuno-deficiency virus in the era of protease inhibitor therapy
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2000) Periodontal diagnoses and classification of periodontal diseases
Periodontol 2000
(2004)Diagnosis of periodontal manifestations of systemic diseases
Periodontol 2000
(2004)- et al.
Periodontol 2000 Global epidemiology of periodontal diseases 29
(2002) - et al.
Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age
J Clin Periodontol
(1986) - et al.
The natural history of periodontal disease in man. The rate of periodontal destruction before 40 years of age
J Periodontol
(1978) - et al.
Prevalence and severity of periodontal diseases and dental caries in Bangladesh
Int Dent J
(1996)