Early diagnosis and treatment of periodontal disease is crucial for helping preserve dentition, decrease inflammation, and prevent further tissue and bone loss.1-3 If inadequately treated, periodontitis not only leads to tooth loss but can also compromise the general physical health of the patient.3,4
A number of factors are associated with increased risk for periodontal disease5-7:
especially if it’s uncontrolled
which is associated with greater loss of attachment and alveolar bone
A combination of clinical parameters should be used to assess periodontal health in patients.
BoP is used to monitor health or inflammation of the gingival tissues. It may be an earlier sign of gingivitis than other signs of inflammation like redness and swelling. BoP is a good clinical indicator for disease progression or periodontal stability.2
PPD should be used in conjunction with BoP (but never alone) to assess oral health. Following successful treatment for periodontitis, recurrent disease can occur at individual sites, despite most of the dentition remaining well maintained and relatively healthy. This indicates that mean values of PPD, attachment levels, and bone height are not adequate predictors for sites that may become reinfected.
The most useful indicator of disease is inflammation. Historical evidence of disease may be of less relevance in the context of periodontal health on a reduced periodontium.2
Radiographs are critical for clinical assessment of the periodontium. They show historical destruction and are valuable for longitudinal determination of progressive bone loss. Once periodontitis has developed, alveolar bone loss has already occurred because of the inflammatory process. At this point, periodontal health on a reduced periodontium cannot be determined using radiographs alone.2
Increased tooth mobility represents a physiological adaptation to altered function rather than a sign of pathology2
It cannot be used as a sign of disease for a tooth with a reduced, but healthy, periodontium2
Poor oral health can have an impact on other body systems.3,4,8 It’s important to communicate this to your patients to help them understand why treatment is important. Talk to patients about how a physical exam can uncover signs of disease, and how oral health can indicate general health status overall.9
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REFERENCES: 1. American Academy of Periodontology. Comprehensive periodontal therapy: a statement by the American Academy of Periodontology. J Periodontol. 2011;82(7):943-949. 2. Lang NP, Bartold PM. Periodontal health. J Periodontol. 2018;89(Suppl 1):S9-S16. 3. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018;89(Suppl 1):S159-S172. 4. Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017;3:17038. 5. Hein C. Getting it right in the long-term management of smoking-related chronic periodontitis. Contemp Oral Hyg. 2003:14-21. 6. Gum disease risk factors. American Academy of Periodontology. Accessed March 29, 2022. https://www.perio.org/for-patients/gum-disease-information/gum-disease-risk-factors/ 7. Gum disease and women. American Academy of Periodontology. Accessed March 29, 2022. https://www.perio.org/for-patients/gum-disease-information/gum-disease-and-women 8. Cullinan MP, Ford PJ, Seymour GJ. Periodontal disease and systemic health: current status. Aust Dent J. 2009;59(1 Suppl):S62-S69. 9. US Department of Health and Human Services. National Institute of Dental and Craniofacial Research. National Institutes of Health. Oral health in America: a report of the Surgeon General. Published 2000. Accessed March 29, 2022. https://iiif.nlm.nih.gov/nlm%3Anlmuid-101584932X142-pgimg-1/full/2544,/0/default.jpg