Periodontics in general practice: perspectives on nonsurgical therapy

Emerging concepts in periodontal therapy

Conventional periodontal therapy consists of mechanical scaling and root planing, and surgical treatment. This is still the mainstay of periodontal treatment. Adjunctive antimicrobial treatments, both systemic and local delivery, are becoming more sophisticated and useful in the treatment of recurrent periodontitis. Also very promising are adjunctive treatments that modulate the host response and decrease levels of destructive pro-inflammatory cytokines or matrix metalloproteinases. Smoking is a major risk factor for periodontitis and has a profound impact on the progression of periodontal bone and attachment loss. In the interest of improved periodontal health patients should be encouraged to stop smoking. Finally bacterial endotoxins that stimulate the release of pro-inflammatory cytokines can have systemic effects and may lead to pre-term, low birthweight babies, and cardiovascular diseases such as atherosclerosis, myocardial infarction and stroke. Health professionals need to be cognisant of the effect dental health can have on systemic diseases and refer for treatment when appropriate to ensure that optimum oral and systemic health is achieved for their patients.

Risk indicators for periodontitis in a military treatment population

The association between the periodontal diagnosis and a variety of subject characteristics was studied in a group of 1,783 patients examined at a large military dental clinic. In order of importance, age greater than 30, smoking, male sex, and Filipino racial background were all found to be statistically significant risk indicators for the presence of moderate or advanced periodontitis. A logistic regression equation serving as a predictive model employing these four variables was presented. The strong association found between smoking and advanced periodontitis is consistent with the hypothesis that smoking has cumulative detrimental effects on periodontal health. While these and other risk indicators are neither causative, diagnostic, nor prognostic, they may be helpful in alerting the clinician to more carefully evaluate other clinical signs or laboratory findings of disease.