A periodontist's view on the assessment of periodontal disease in the community.
Periodontal treatment differs from other forms of dental treatment in that it demands long term cooperation from the patient without which the dentists' efforts are largely without value. The earliest stage of periodontal disease is gingivitis which is characterized by bleeding on gentle probing. It is a reversible condition which, depending on many poorly understood factors, may or may not progress to periodontal disease. This stage is characterized by the apical migration of junctional epithelium, pocket formation and loss of alveolar bone. Pocket depth, though not indicating the presence of active disease, is the best available measure of periodontal disease. In school children the majority of disease is gingivitis which can be largely eliminated by plaque control which they should be taught to practise from themselves. In adults a screening procedure has been developed which will rapidly identify those in need of treatment. Patients with gingivitis can be referred to hygienists. Those with moderately advanced disease are scheduled for non-surgical periodontal therapy which should be followed by re-evaluation and redefinition of the treatment plan. Those with advanced periodontal disease are usually referred for specialist treatment. It has been shown that pockets of up to 5 mm in depth can be maintained without further destruction by plaque control combined with scaling and root planing. The most important aspect of periodontal health remains the quality of long term maintenance care and the motivation of the patient to accept responsibility for it.
PubMed Abstracts
PubMed Abstracts