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Understanding the pathogenesis of periodontal disease in relation to prevention and treatment 

Understanding the pathogenesis of periodontal disease in relation to prevention and treatment 

Find out how developing your understanding of periodontal disease can help you prevent tooth loss in patients.

Restorative dentistry is the ‘umbrella discipline’ consisting of the mono-speciality disciplines of periodontics, endodontics and prosthodontics. In this post we will cover periodontics, part of module 3 of the MSc in Restorative Dental Science, highlighting how this supports enhancing quality of care in this key area.  

Periodontal diseases  

Periodontal diseases are one of most common chronic inflammatory diseases globally, affecting 20-50% of the global population.1 This prevalence has remained largely unchanged over the last 25 years2 with the latest evidence suggesting 19% has severe disease.3 If left untreated, periodontal disease is the main cause of tooth loss and is considered one the main threats to oral health in adults.4

Evidence also links periodontal diseases with systemic diseases such as cardiovascular disease and diabetes.1 The pathogenesis of periodontal disease is complex with evidence indicating it is the patient’s response to the bacterial challenge which is the major determinant of susceptibility.5 

An appreciation of dental plaque and the host response therefore provides an essential basis from which to understand the disease process and treatment rationale. As ever, early detection plays an important role in prevention, progression and positive treatment outcomes.

It has been understood  that a thorough history combined with comprehensive clinical and radiographic assessment are required so an accurate diagnosis can be made.  Also, an important part of the periodontal assessment is to identify the risk factors which influence susceptibility to periodontal disease and likelihood of periodontitis developing in an individual along with how fast it progresses.6 

S3 Treatment guidelines for periodontitis 

A need for evidence-based clinical guidelines providing recommendations to treat periodontitis was highlighted at a world workshop held in 2017. This workshop reviewed the classification of periodontitis, incorporating stages and grades of disease, prevention and treatment, and severity and extent of complexity of an individual's risk.4 

As a result of this workshop The European Federation of Periodontology (EFP) developed the S3-level clinical practice guideline in 2019. This guidance approaches the treatment of periodontitis using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions.

It also includes recommendations covering different interventions including behavioural change, supragingival biofilm, gingival inflammation and risk factor control; supra- and sub-gingival instrumentation, with and without adjunctive therapies; different types of periodontal surgical interventions; and the necessary supportive periodontal care to extend benefits over time.4 

Module 3 of the MSc in Restorative Dental Science includes an evidence-based focus on the prevention and treatment of periodontal diseases. It also covers diagnosis and techniques for management of periodontal pathology to devise appropriate strategies for the delivery of quality care.

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References:

  1. Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017 Apr-Jun;11(2):72-80. 

  2. The Economist – Time to take gum disease seriously https://impact.economist.com/perspectives/sites/default/files/eiu-efp-oralb-gum-disease.pdf

  3. World Health Organisation https://www.who.int/news-room/fact-sheets/detail/oral-health 

  4. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology. 2020;47(S22):4-60)

  5. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-858

  6. Van Dyke TE, Sheilesh Risk factors for periodontitis. J Int Acad Periodontol. 2005 Jan;7(1):3-7. PMID: PMC1351013

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