Current concepts and an alternative perspective on periodontal disease
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Current concepts and an alternative perspective on periodontal disease Gunnar Dahlen1* , Ole Fejerskov2 and Firoze Manji3
Abstract Background: Epidemiological data from countries worldwide show a consistent pattern implying that a fraction of around 10% of those over 40–50 years in all populations will exhibit severe periodontitis with the potential risk of losing teeth during their life-time. The subgingival microbiota shows striking similarities between populations irrespective of disease severity and can only marginally explain the clinical pattern. It is also difficult to explain this pattern by genetic and acquired risk factors such as systemic disease (e.g. diabetes) or habits (e.g. smoking) even if they may have a confounding effect on the disease. Main text: Inflammation of the gingiva appears to be a normal and physiological response to the presence of commensal bacteria along the gingival crevice and in the dental biofilm. Over many years of exposure to the dental biofilm, the chronic inflammation in the gingiva gradually results in a loss of attachment and bone loss. Numerous laboratory and clinical studies have provided insight into the potential role of determinants that are associated with periodontitis. However, it has been difficult to relate the findings to the pattern of the distribution of the disease observed in epidemiological studies. We propose a simple and parsimonious model that considers all the multitude of potential determinants as creating effectively random noise within the dental biofilm to which the tissues react by accumulating the effects of this noise. Conclusions: We suggest that such a model can explain many of the epidemiological features of periodontal breakdown over time, and we discuss its clinical implications. Keywords: Periodontitis, Oral microbiome, Inflammation, Host-pathogen response, Epidemiology
Introduction One of the most striking, and perhaps enigmatic, features of the epidemiology of periodontitis is the similarity in the patterns of periodontal loss of attachment in different populations across the world, whether or not they exhibit poor oral hygiene, or receive regular oral health care [1, 2]. What we find is that gingival inflammation of some degree is ubiquitous from childhood to old age; the progress of periodontitis is slow, with loss of attachment occurring after the age of 30–40 years, with * Correspondence: [email protected] 1 Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 450, 40530 Gothenburg, Sweden Full list of author information is available at the end of the article
some degree of loss occurring in everyone; advanced loss of attachment occurs in a minority of the population and increases with age to a prevalence of 10–15%; loss of attachment occurs on buccal and lingual surfaces often accompanied by gingival recession, whereas pocket formation predominates in proximal spaces, often bilaterally; and the core oral microbiome (commensals), includ
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