Current Evidence in Periodontal Diseases

Partido, B.B.

Etiology, Risk Factors, and Periodontal Diseases

 Plaque/biofilm contributes to the inflammatory process that leads to periodontal destruction. The existing literature consists of cross-sectional and longitudinal studies supporting the quantity and quality of plaque and periodontal diseases. However, the literature does not explain why certain people develop periodontal disease and other do not. The literature also does not support the reduction of plaque levels in the prevention or control of periodontal diseases.

Tobacco/smoking has been found to be a risk factor for periodontal disease. It remains difficult to isolate smoking/tobacco use because there are other systemic concerns (i.e. cardiovascular, cancer) associated with its use. Because causality cannot be established with randomized controlled trials (RCTs), the best available evidence used longitudinal cohort research designs. There is sufficient evidence to support smoking as a causative agent in periodontal destruction.

Diabetes is another risk factor for periodontal disease. The best available evidence used longitudinal cohort research designs. In the relationship between diabetes and periodontal disease, the prevalence of diabetes could increase the prevalence and/or severity of periodontal disease. The current literature involved a randomized controlled trial that showed that nonsurgical periodontal therapy had no effect on glycemic control (HbA1C levels).

Nonsurgical Periodontal Therapy

The professional delivery of plaque control methods/instruction have shown minimal effects. Plaque control instruction has led to minimal changes in gingivitis and limited evidence exists that supports whether plaque control alone prevents or controls periodontal disease. The patterns of response to oral hygiene instructions may vary and the biggest differences may be due to ethnicity.

Efforts toward tobacco cessation may have a greater impact on the response to nonsurgical periodontal therapy. The two broad categories of tobacco cessation programs include pharmacologic agents or behavioral counseling.

The traditional methods of scaling and root planing has shown to be most effective in pockets with the most periodontal destruction. The use of systemic antibiotics may be used on specific patients at high risk of other systemic disease and with poor response to traditional methods. However, caution must be used to avoid the risks of antibiotic resistance. The localized delivery of antibiotics (LDA’s) may be considered when a localized pocket has recurrent or residual inflammation after traditional methods.  LDA’s should not be considered if there are generalized recurrent/residual areas of inflammation, unresponsive to previous LDA treatment, or anatomical defects.

Evidence has supported the effectiveness of periodontal maintenance in the stability of periodontal health. However, limited evidence supports the proper interval for periodontal maintenance visits.