Chronic periodontitis
Encyclopedia
Chronic periodontitis is a common disease
of the oral cavity consisting of chronic
inflammation
of the periodontal tissues
that is caused by accumulation of profuse amounts of dental plaque
.
Symptoms may include the following:
Gingival inflammation and bone destruction are often painless. Patients sometimes assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing chronic periodontitis in that patient.
Subgingival calculus is a frequent finding.
There is a slow to moderate rate of disease progression but the patient may have periods of rapid progression ("bursts of destruction"). Chronic periodontitis can be associated with local predisposing factors(e.g. tooth-related or iatrogenic factors). The disease may be modified by and be associated with systemic diseases (e.g. diabetes mellitus
, HIV
infection) It can also be modified by factors other than systemic disease such as smoking
and emotional stress
.
Major risk factors: Smoking, lack of oral hygiene
with inadequate plaque biofilm
control.
Measuring disease progression is carried out by measuring probing pocket depth (PPD) and bleeding indices using a periodontal probe
. Pockets greater than 3mm in depth are considered to be unhealthy. Bleeding on probing is considered to be a sign of active disease. Discharge of pus, involvement of the root furcation area and deeper pocketing may all indicate reduced prognosis for an individual tooth.
Age is related to the incidence of periodontal destruction: "...in a well-maintained population who practises oral home care and has regular check-ups, the incidence of incipient periodontal destruction increases with age, the highest rate occurs between 50 and 60 years, and gingival recession is the predominant lesion before 40 years, while periodontal pocketing is the principal mode of destruction between 50 and 60 years of age."
tooth-associated microbial biofilms that elicit a host
response, which results in bone
and soft tissue destruction. In response to endotoxin
derived from periodontal pathogen
s, several osteoclast
-related mediators target the destruction of alveolar bone and supporting connective tissue
such as the periodontal ligament
. Major drivers of this aggressive tissue destruction are matrix metalloproteinase
s (MMPs), cathepsins, and other osteoclast-derived enzymes.
The disease is associated with a variable microbial pattern.
Anaerobic
species of bacteria Porphyromonas gingivalis
, Bacteroides forsythus
, Treponema denticola
, Prevotella intermedia
, Fusobacterium nucleatum
, Eubacterium
sp. have all been implicated in chronic periodontitis.
Microaerophile
bacteria Actinomyces actinomycetemcomitans, Campylobacter rectus
, and Eikenella corrodens also may play a role in chronic periodontitis.
and good oral hygiene
are key to effective treatment and positive outcomes for patients.
The typical initial treatment known to be effective is scaling and root planing
(SRP) to mechanically debride the depths of the periodontal pocket and disturb the biofilm
present. This is done using a powered ultrasonic
or sonic scaler or unpowered hand instruments.
"In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone".
Full mouth disinfection
protocols are favoured by some clinicians: "In patients with chronic periodontitis in moderately deep pockets slightly more favourable outcomes for pocket reduction and gain in probing attachment were found following FMD compared to control. However, these additional improvements were only modest and there was only a very limited number of studies available for comparison, thus limiting general conclusions about the clinical benefit of full-mouth disinfection."
Open flap debridement
is used by some practitioners particularly in deeper pocket areas. The advantages of this approach is better visualization of the root surface to be cleaned. This must be weighed against the risks of surgery. Open flap surgery is more effective than non-surgical periodontal therapy in deep pocketing : "Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain."
Guided tissue regeneration (GTR) using PTFE membranes
is favoured by some practitioners, despite its cost and complexity: "GTR has a greater effect on probing measures of periodontal treatment than open flap debridement, including improved attachment gain, reduced pocket depth, less increase in gingival recession and more gain in hard tissue probing at re-entry surgery. However there is marked variability between studies and the clinical relevance of these changes is unknown. As a result, it is difficult to draw general conclusions about the clinical benefit of GTR. Whilst there is evidence that GTR can demonstrate a significant improvement over conventional open flap surgery, the factors affecting outcomes are unclear from the literature and these might include study conduct issues such as bias. Therefore, patients and health professionals need to consider the predictability of the technique compared with other methods of treatment before making final decisions on use."
Enamel matrix derivative
(EMD) is favoured by some practitioners despite its high cost: "One year after its application, EMD significantly improved probing attachment levels (1.1 mm) and probing pocket depth reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less gingival recession than EMD."
or metronidazole
are sometimes used in addition to debridement based treatments.
"Systemic antimicrobials in conjunction with scaling and root planing (SRP), can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of clinical attachment loss (CAL) and probing pocket depth (PPD) change, and reduced risk of additional CAL loss. However, differences in study methodology and lack of data precluded an adequate and complete pooling of data for a more comprehensive analyses. It was difficult to establish definitive conclusions, although patients with deep pockets, progressive or 'active' disease, or specific microbiological profile, can benefit more from this adjunctive therapy."
"Among the locally administered adjunctive antimicrobials, the most positive results occurred for tetracycline, minocycline, metronidazole, and chlorhexidine. Adjunctive local therapy generally reduced PD levels....Whether such improvements, even if statistically significant, are clinically meaningful remains a question."
Minocycline
is typically delivered via slim syringe applicators.
Chlorhexidine impregnated chips are also available.
(SDD) have been used to alter host response to the periodontal pathogens. This is believed to disrupt the action of matrix metalloproteinases and thus minimise host mediated tissue destruction.
"The adjunctive use of SDD with SRP is statistically more effective than SRP alone in reducing PD and in achieving CAL gain."
Lasers are increasingly being used in treatments for chronic periodontitis. However there is some controversy over their use:
"No consistent evidence supports the efficacy of laser treatment as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis."
.
There is little evidence linking progression of periodontal disease to low birth weight or preterm birth:
"In these women with periodontitis and within this study's limitations, disease progression was not associated with an increased risk for delivering a pre-term or a low birthweight infant."
There is recently emerged evidence linking chronic periodontitis with head and neck squamous cell carcinoma
: "Patients with periodontitis were more likely to have poorly differentiated oral cavity SCC than those without periodontitis (32.8% versus 11.5%; P = 0.038)".
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
of the oral cavity consisting of chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the periodontal tissues
Periodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
that is caused by accumulation of profuse amounts of dental plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...
.
Diagnosis
It is one of the seven destructive periodontal diseases as listed in the 1999 classification.Signs and symptoms
In the early stages, chronic periodontitis has few symptoms and in many individuals the disease has progressed significantly before they seek treatment.Symptoms may include the following:
- Redness or bleeding of gums while brushing teethToothTeeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...
, using dental floss or biting into hard food (e.g. apples) (though this may occur even in gingivitisGingivitisGingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...
, where there is no attachment loss) - Gum swelling that recurs
- HalitosisHalitosisHalitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease.- General :...
, or bad breath, and a persistent metallic taste in the mouth - Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff tooth brush.)
- Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenasesCollagenasesCollagenases are enzymes that break the peptide bonds in collagen.They assist in destroying extracellular structures in pathogenesis of bacteria such as Clostridium. They are an exotoxin and help to facilitate the spread of gas gangrene...
) - Loose teeth, in the later stages (though this may occur for other reasonsOcclusal traumaOcclusal trauma is a dental term that refers to the damage incurred when teeth are left in traumatic occlusion without proper treatment.When the maxillary and mandibular dental arches approach each together, as they do, for example, during chewing or at rest, the relationship between the opposing...
as well)
Gingival inflammation and bone destruction are often painless. Patients sometimes assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing chronic periodontitis in that patient.
Subgingival calculus is a frequent finding.
There is a slow to moderate rate of disease progression but the patient may have periods of rapid progression ("bursts of destruction"). Chronic periodontitis can be associated with local predisposing factors(e.g. tooth-related or iatrogenic factors). The disease may be modified by and be associated with systemic diseases (e.g. diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
infection) It can also be modified by factors other than systemic disease such as smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
and emotional stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
.
Major risk factors: Smoking, lack of oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
with inadequate plaque biofilm
Biofilm
A biofilm is an aggregate of microorganisms in which cells adhere to each other on a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance...
control.
Measuring disease progression is carried out by measuring probing pocket depth (PPD) and bleeding indices using a periodontal probe
Periodontal probe
A periodontal probe is an instrument in dentistry commonly used in the dental armamentarium. It is usually long, thin, and blunted at the end. The primary purpose of a periodontal probe is to measure pocket depths around a tooth in order to establish the state of health of the periodontium...
. Pockets greater than 3mm in depth are considered to be unhealthy. Bleeding on probing is considered to be a sign of active disease. Discharge of pus, involvement of the root furcation area and deeper pocketing may all indicate reduced prognosis for an individual tooth.
Age is related to the incidence of periodontal destruction: "...in a well-maintained population who practises oral home care and has regular check-ups, the incidence of incipient periodontal destruction increases with age, the highest rate occurs between 50 and 60 years, and gingival recession is the predominant lesion before 40 years, while periodontal pocketing is the principal mode of destruction between 50 and 60 years of age."
Pathology
Chronic periodontitis is initiated by Gram-negativeGram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...
tooth-associated microbial biofilms that elicit a host
Host (biology)
In biology, a host is an organism that harbors a parasite, or a mutual or commensal symbiont, typically providing nourishment and shelter. In botany, a host plant is one that supplies food resources and substrate for certain insects or other fauna...
response, which results in bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
and soft tissue destruction. In response to endotoxin
Endotoxin
Endotoxins are toxins associated with some Gram-negative bacteria. An "endotoxin" is a toxin that is a structural molecule of the bacteria that is recognized by the immune system.-Gram negative:...
derived from periodontal pathogen
Periodontal pathogen
Periodontal pathogens are bacteria that have been shown to significantly contribute to periodontitis.Although approximately 700 bacterial species have been identified in the oral cavity and nearly 300 species have been cultured and found to contribute to the biofilm of the periodontal pocket, there...
s, several osteoclast
Osteoclast
An osteoclast is a type of bone cell that removes bone tissue by removing its mineralized matrix and breaking up the organic bone . This process is known as bone resorption. Osteoclasts were discovered by Kolliker in 1873...
-related mediators target the destruction of alveolar bone and supporting connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
such as the periodontal ligament
Periodontal ligament
The periodontal fiber or periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits...
. Major drivers of this aggressive tissue destruction are matrix metalloproteinase
Metalloproteinase
Metalloproteinases constitute a family of enzymes from the group of proteases, classified by the nature of the most prominent functional group in their active site. These are proteolytic enzymes whose catalytic mechanism involves a metal. Most metalloproteases are zinc-dependent, but some use...
s (MMPs), cathepsins, and other osteoclast-derived enzymes.
Microbiology
There are two views of the microbiology of periodontitis: the specific plaque hypothesis and the non specific plaque hypothesis.The disease is associated with a variable microbial pattern.
Anaerobic
Anaerobic organism
An anaerobic organism or anaerobe is any organism that does not require oxygen for growth. It could possibly react negatively and may even die if oxygen is present...
species of bacteria Porphyromonas gingivalis
Porphyromonas gingivalis
Porphyromonas gingivalis belongs to the phylum Bacteroidetes and is a non-motile, gram-negative, rod-shaped, anaerobic pathogenic bacterium. It forms black colonies on blood agar....
, Bacteroides forsythus
Bacteroides forsythus
Bacteroides forsythus is a species of bacteria.It is sometimes equated with Tannerella forsythia.It is found in deep subgingival pockets and is associated with aggressive periodontitis.-References:...
, Treponema denticola
Treponema denticola
Treponema denticola is a motile and highly proteolytic bacterium. The Gram-negative oral spirochete is associated with the incidence and severity of human periodontal disease. Treponema denticola levels in the mouth are elevated in patients with periodontal diseases and the species is considered...
, Prevotella intermedia
Prevotella intermedia
Prevotella intermedia is a gram-negative obligate anaerobic pathogen involved in periodontal infections, including gingivitis and periodontitis, and often found in Acute necrotizing ulcerative gingivitis . It is commonly isolated from Dentoalveolar abscesses, where obligate anaerobes...
, Fusobacterium nucleatum
Fusobacterium nucleatum
Fusobacterium nucleatum is an oral bacterium, indigenous to the human oral cavity, that plays a role in periodontal disease. This organism is commonly recovered from different monomicrobial and mixed infections in humans and animals...
, Eubacterium
Eubacterium
Eubacterium is a Gram positive bacteria genus in the family Eubacteriaceae....
sp. have all been implicated in chronic periodontitis.
Microaerophile
Microaerophile
A microaerophile is a microorganism that requires oxygen to survive, but requires environments containing lower levels of oxygen than are present in the atmosphere . Many microphiles are also capnophiles, as they require an elevated concentration of carbon dioxide. In the laboratory they can be...
bacteria Actinomyces actinomycetemcomitans, Campylobacter rectus
Campylobacter rectus
Campylobacter rectus is a species of Campylobacter. It is implicated as a pathogen in chronic periodontitis which can induce bone loss. It is a gram negative motile, aerotolerant rod....
, and Eikenella corrodens also may play a role in chronic periodontitis.
Treatment
There is professional agreement among dentists that smoking cessationSmoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...
and good oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
are key to effective treatment and positive outcomes for patients.
The typical initial treatment known to be effective is scaling and root planing
Scaling and root planing
The objective of scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its products and calculus, thus helping to establish a...
(SRP) to mechanically debride the depths of the periodontal pocket and disturb the biofilm
Biofilm
A biofilm is an aggregate of microorganisms in which cells adhere to each other on a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance...
present. This is done using a powered ultrasonic
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...
or sonic scaler or unpowered hand instruments.
"In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone".
Full mouth disinfection
Full mouth disinfection
Full mouth disinfection typically refers to an intense course of treatment for periodontitis typically involving scaling and root planing in combination with adjunctive use of local antimicrobial adjuncts to periodontal treatment such as chlorhexidine in various ways of application...
protocols are favoured by some clinicians: "In patients with chronic periodontitis in moderately deep pockets slightly more favourable outcomes for pocket reduction and gain in probing attachment were found following FMD compared to control. However, these additional improvements were only modest and there was only a very limited number of studies available for comparison, thus limiting general conclusions about the clinical benefit of full-mouth disinfection."
Open flap debridement
Open flap debridement
In dentistry, open flap debridement is a periodontal procedure in which the supporting alveolar bone and root surfaces of teeth are exposed by incising the gingiva to provide increased access for scaling and root planing. While the efficacy of this treatment is debated, it is almost always...
is used by some practitioners particularly in deeper pocket areas. The advantages of this approach is better visualization of the root surface to be cleaned. This must be weighed against the risks of surgery. Open flap surgery is more effective than non-surgical periodontal therapy in deep pocketing : "Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain."
Guided tissue regeneration (GTR) using PTFE membranes
Artificial membrane
An artificial membrane, or synthetic membrane, is a synthetically created membrane which is usually intended for separation purposes in laboratory or in industry. Synthetic membranes have been successfully used for small and large-scale industrial processes since the middle of twentieth century. A...
is favoured by some practitioners, despite its cost and complexity: "GTR has a greater effect on probing measures of periodontal treatment than open flap debridement, including improved attachment gain, reduced pocket depth, less increase in gingival recession and more gain in hard tissue probing at re-entry surgery. However there is marked variability between studies and the clinical relevance of these changes is unknown. As a result, it is difficult to draw general conclusions about the clinical benefit of GTR. Whilst there is evidence that GTR can demonstrate a significant improvement over conventional open flap surgery, the factors affecting outcomes are unclear from the literature and these might include study conduct issues such as bias. Therefore, patients and health professionals need to consider the predictability of the technique compared with other methods of treatment before making final decisions on use."
Enamel matrix derivative
Enamel matrix derivative
In dentistry, enamel matrix derivative is an extract of porcine fetal tooth material used to biomimetically stimulate the soft and hard tissues surrounding teeth to regrow following tissue destruction....
(EMD) is favoured by some practitioners despite its high cost: "One year after its application, EMD significantly improved probing attachment levels (1.1 mm) and probing pocket depth reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less gingival recession than EMD."
Adjunctive systemic antibiotic treatment
Systemic antibiotics such as amoxicillinAmoxicillin
Amoxicillin , formerly amoxycillin , and abbreviated amox, is a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. It is usually the drug of choice within the class because it is better absorbed, following oral...
or metronidazole
Metronidazole
Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....
are sometimes used in addition to debridement based treatments.
"Systemic antimicrobials in conjunction with scaling and root planing (SRP), can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of clinical attachment loss (CAL) and probing pocket depth (PPD) change, and reduced risk of additional CAL loss. However, differences in study methodology and lack of data precluded an adequate and complete pooling of data for a more comprehensive analyses. It was difficult to establish definitive conclusions, although patients with deep pockets, progressive or 'active' disease, or specific microbiological profile, can benefit more from this adjunctive therapy."
Locally delivered adjunctive antimicrobial treatment
Chemical antimicrobials may be used by the clinician to help reduce the bacterial load in the diseased pocket."Among the locally administered adjunctive antimicrobials, the most positive results occurred for tetracycline, minocycline, metronidazole, and chlorhexidine. Adjunctive local therapy generally reduced PD levels....Whether such improvements, even if statistically significant, are clinically meaningful remains a question."
Minocycline
Minocycline
Minocycline is a broad-spectrum tetracycline antibiotic, and has a broader spectrum than the other members of the group. It is a bacteriostatic antibiotic, classified as a long-acting type...
is typically delivered via slim syringe applicators.
Chlorhexidine impregnated chips are also available.
Modulating the host response
Sub-antimicrobial doses of doxycyclineDoxycycline
Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...
(SDD) have been used to alter host response to the periodontal pathogens. This is believed to disrupt the action of matrix metalloproteinases and thus minimise host mediated tissue destruction.
"The adjunctive use of SDD with SRP is statistically more effective than SRP alone in reducing PD and in achieving CAL gain."
Current controversies in chronic periodontal disease management
"There is no good evidence to show whether routine scale and polishing prevents chronic periodontitis."Lasers are increasingly being used in treatments for chronic periodontitis. However there is some controversy over their use:
"No consistent evidence supports the efficacy of laser treatment as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis."
Costs of treatment
"Costs for tooth retention via supportive periodontal therapy are relatively low compared with alternatives (e.g. implants or bridgework) even in periodontally impaired teeth.". However, health outcomes of periodontal therapy are not directly comparable with those from implants or bridgework.Tentative links to other conditions
There is only very weak evidence linking to coronary heart diseaseCoronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...
.
There is little evidence linking progression of periodontal disease to low birth weight or preterm birth:
"In these women with periodontitis and within this study's limitations, disease progression was not associated with an increased risk for delivering a pre-term or a low birthweight infant."
There is recently emerged evidence linking chronic periodontitis with head and neck squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
: "Patients with periodontitis were more likely to have poorly differentiated oral cavity SCC than those without periodontitis (32.8% versus 11.5%; P = 0.038)".
External links
- British Society for Periodontology
- American Society of Periodontology
- http://www.uic.edu/classes/peri/peri323/syallbus/class/charac1.htm