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)
Periodontal disease among indigenous people in the Amazon rain forest
J Clin Periodontol
Destructive periodontal disease in adults 30 years of age and older in the United States, 1988–1994
J Periodontol
Structure of the microbial flora associated with periodontal health and disease in man. A light and electron microscopic study
J Periodontol
The bacteria of periodontal diseases
Periodontol 2000
Bacterial diversity within the human subgingival crevice
Proc Natl Acad Sci USA
Methanogenic Archaea and human periodontal disease
Proc Natl Acad Sci USA
Comparison of the microbiota of supra- and subgingival plaque in health and periodontitis
J Clin Periodontol
Microbiota of health, gingivitis, and initial periodontitis
J Clin Periodontol
Clinical, microbiological and immunological profile of healthy, gingivitis and putative active periodontal subjects
J Periodontal Res
Bacterial colonization during de novo plaque formation
J Clin Periodontol
Microbiology of periodontal disease
Toothbrushing frequency as it relates to plaque development and gingival health
J Periodontol
Does oral health promotion improve oral hygiene and gingival health?
Periodontol 2000
Subgingival microbial profiles in refractory periodontal disease
J Clin Periodontol
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
Microbial complexes in subgingival plaque
J Clin Periodontol
Evidence of bacterial etiology: a historical perspective
Periodontol 2000
Studies of the microbiology of periodontosis
J Periodontol
A selective medium for Actinobacillus actinomycetemcomitans and the incidence of the organism in juvenile periodontitis
J Periodontol
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
Human herpesviruses and Porphyromonas gingivalis are associated with juvenile periodontitis
J Periodontol
Herpesviruses, the missing link between gingivitis and periodontitis?
J Int Acad Periodontol
The significance and management of periodontal lesions in HIV infection
Oral Dis
Subgingival microbiota of chronic periodontitis subjects from different geographic locations
J Clin Periodontol
Risk factors for periodontitis
J Int Acad Periodontol
Mutations of the cathepsin C gene are responsible for Papillon-Lefevre syndrome
J Med Genet
Loss-of-function mutations in the cathepsin C gene result in periodontal disease and palmoplantar keratosis
Nat Genet
Haim-Munk syndrome and Papillon-Lefevre syndrome are allelic mutations in cathepsin C
J Med Genet
The role of cathepsin C in Papillon-Lefevre syndrome, prepubertal periodontitis, and aggressive periodontitis
Hum Mutat
Periodontal findings in adult twins
J Periodontol
A twin study of genetic variation in proportional radiographic alveolar bone height
J Dent Res
Evidence of a substantial genetic basis for risk of adult periodontitis
J Periodontol
Self-reported periodontal disease in a Virginia twin population
J Periodontol
The interleukin-1 genotype as a severity factor in adult periodontal disease
J Clin Periodontol
Genes and gene polymorphisms associated with periodontal disease
Crit Rev Oral Biol Med
A critical assessment of interleukin-1 (IL-1) genotyping when used in a genetic susceptibility test for severe chronic periodontitis
J Periodontol
Tobacco smoking and chronic destructive periodontal disease
Odontology
Relation between tobacco consumption and oral health in Swedish schoolchildren
Acta Odontol Scand
Impact of tobacco use on periodontal status
J Dent Educ
Periodontal effects associated with the use of smokeless tobacco
J Periodontol
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