Periodontal disease as a specific, albeit chronic, infection: diagnosis and treatment - PubMed (original) (raw)

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Periodontal disease as a specific, albeit chronic, infection: diagnosis and treatment

W J Loesche et al. Clin Microbiol Rev. 2001 Oct.

Abstract

Periodontal disease is perhaps the most common chronic infection in adults. Evidence has been accumulating for the past 30 years which indicates that almost all forms of periodontal disease are chronic but specific bacterial infections due to the overgrowth in the dental plaque of a finite number of mostly anaerobic species such as Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola. The success of traditional debridement procedures and/or antimicrobial agents in improving periodontal health can be associated with the reduction in levels of these anaerobes in the dental plaque. These findings suggest that patients and clinicians have a choice in the treatment of this overgrowth, either a debridement and surgery approach or a debridement and antimicrobial treatment approach. However, the antimicrobial approach, while supported by a wealth of scientific evidence, goes contrary to centuries of dental teaching that states that periodontal disease results from a "dirty mouth." If periodontal disease is demonstrated to be a risk factor for cardiovascular disease and stroke, it will be a modifiable risk factor since periodontal disease can be prevented and treated. Since the antimicrobial approach may be as effective as a surgical approach in the restoration and maintenance of a periodontally healthy dentition, this would give a cardiac or stroke patient and his or her physician a choice in the implementation of treatment seeking to improve the patient's periodontal condition so as to reduce and/or delay future cardiovascular events.

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Figures

FIG. 1

FIG. 1

Patient with advanced adult periodontitis. (A) Prior to treatment. The patient came to the clinic seeking replacement for missing tooth. He was not aware of having a periodontal problem, despite gingival bleeding and massive amounts of supragingival plaque and calculus about the teeth. Note the whitish material at junction where the teeth contact the gingival tissue, especially about the canine tooth on the lower right. (B) After the plaque and calculus have been removed. There has been considerable bone loss about certain teeth, which accounts for the exposed roots.

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