Preface

"Periodontal diseases" is a comprehensive web-based resource on different aspects of periodontal conditions: recognition, microbial aetiology, immunopathogenesis, modifying factors, diagnosis, and treatment of periodontal diseases in the practice of dentistry. The aim of this book is to provide an amalgamated content containing of evidence-based reviews and research on the recent advances in periodontal diseases. This multifaceted web-resource has utilized the collaboration of numerous specialists and researchers from around the world to integrate the elaborate number of topics within the subject area of periodontal diseases. Although an attempt at a comprehensive coverage of aetiology, pathogenesis and clinical concepts has been made, due to time and space limitations we were not able to cover the vast array of research studies that is still being done in the field of periodontal diseases. The topics covered are either research studies or reviews on the following topics:


The information presented in this publication is intended to reach the contemporary practitioners, as well as educators and students in the field of periodontology. It is fully searchable and designed to enhance the learning experience. The content is produced to challenge the reader and provide clear information. This book provides a unique insight into the various emerging concepts in periodontal diseases from an international perspective.

Furthermore, there is research-based material on the role of molecular factors such as the cytokines, proteases and protease inhibitors, and the role of epigenetic status in health and disease. Many patients with the same clinical symptoms respond differently to the same therapy, suggesting the inter-individual variability observed as a clinical outcome of the disease is influenced by genetic as well as epigenetic factors. There is a contemporary insight into the oral innate and adaptive immune responses

#### X Preface

with elucidation into the development of potential innovative therapeutic interventions for periodontal disease.

Mounting evidence is available indicating periodontitis as a risk factor for various systemic diseases such as cardiovascular diseases, diabetes mellitus, osteoporosis, hematologic disorder, immune system disorders, gastrointestinal disorders, rheumatoid arthritis, pulmonary diseases and adverse effects in pregnancy. Several mechanisms have been proposed here to explain how periodontal disease initiated by microorganisms in the dental plaque and host modulation can contribute to the development of cardiovascular diseases and bidirectional effects in diabetes mellitus, **rheumatoid arthritis**. Risk factors, such as smoking, genetics, stress and increasing age, could independently lead to periodontal disease and to cardiovascular disease. There is an increase in the amount of research being performed on genetic susceptibility to periodontal disease influenced by exposure to smoking or the effect of smoking on periodontal disease as a bilateral modulating factor. Another chapter in this book presents an epidemiological investigation into the periodontal and oral hygiene status, measured according to socio-demographic and behavioural parameters in different populations, and comparative analysis. This contribution emphasizes the need for dental practitioners as well as dental public health policy makers to work towards equity in oral health and focus not only on dental characteristics but also on the life characteristics of older adults, and on their quality of life issues.

A variety of pharmacological treatment strategies is reviewed here in addition to SRP, involving antimicrobials to chemo mechanics developed to target the host response to LPS-mediated tissue destruction and MMP Inhibitors in the treatment of periodontitis. In the last decades, laser therapy has been proposed as an alternative or as a complement to conventional non-surgical therapy, due to its capability to obtain tissue ablation and haemostasis, bactericidal effect against periodontal pathogens and detoxification of root surface. Several studies have reported the use of PDT therapy as an addition to nonsurgical treatment for initial and supportive therapy of chronic periodontitis. A deliberation of modern treatment strategies to manage periodontitis has been considered here, which is a challenging field of on-going research.

> **Dr. Jane Manakil,**  School of Dentistry and Oral Health Faculty of Health Gold Coast campus, Griffith University, Australia

X Preface

life issues.

interventions for periodontal disease.

with elucidation into the development of potential innovative therapeutic

Mounting evidence is available indicating periodontitis as a risk factor for various systemic diseases such as cardiovascular diseases, diabetes mellitus, osteoporosis, hematologic disorder, immune system disorders, gastrointestinal disorders, rheumatoid arthritis, pulmonary diseases and adverse effects in pregnancy. Several mechanisms have been proposed here to explain how periodontal disease initiated by microorganisms in the dental plaque and host modulation can contribute to the development of cardiovascular diseases and bidirectional effects in diabetes mellitus, **rheumatoid arthritis**. Risk factors, such as smoking, genetics, stress and increasing age, could independently lead to periodontal disease and to cardiovascular disease. There is an increase in the amount of research being performed on genetic susceptibility to periodontal disease influenced by exposure to smoking or the effect of smoking on periodontal disease as a bilateral modulating factor. Another chapter in this book presents an epidemiological investigation into the periodontal and oral hygiene status, measured according to socio-demographic and behavioural parameters in different populations, and comparative analysis. This contribution emphasizes the need for dental practitioners as well as dental public health policy makers to work towards equity in oral health and focus not only on dental characteristics but also on the life characteristics of older adults, and on their quality of

A variety of pharmacological treatment strategies is reviewed here in addition to SRP, involving antimicrobials to chemo mechanics developed to target the host response to LPS-mediated tissue destruction and MMP Inhibitors in the treatment of periodontitis. In the last decades, laser therapy has been proposed as an alternative or as a complement to conventional non-surgical therapy, due to its capability to obtain tissue ablation and haemostasis, bactericidal effect against periodontal pathogens and detoxification of root surface. Several studies have reported the use of PDT therapy as an addition to nonsurgical treatment for initial and supportive therapy of chronic periodontitis. A deliberation of modern treatment strategies to manage periodontitis

**Dr. Jane Manakil,** 

Gold Coast campus, Griffith University,

Australia

School of Dentistry and Oral Health Faculty of Health

has been considered here, which is a challenging field of on-going research.

**Part 1** 

**Aetiology of Periodontal Diseases** 

**Part 1** 

**Aetiology of Periodontal Diseases** 

**1** 

**The Microbial Aetiology of** 

The study of the aetiology of periodontal diseases has continued for decades with much progress shown in the last two decades. Having moved through periods of "whole" plaque (with emphasis on mass) being attributed to the disease process, to "specific" species being implicated, we have finally returned to examining the oral microbiota as an ecological niche involving not only a selected few species but looking at plaque as a whole where all the players are invited to participate with their roles no longer individually defined but viewed as a team effort with recognition of their individual strengths and contributions. Recent findings using advanced technology, are confirming findings viewed by electron microscopy nearly half a century ago, but we now have the knowledge and expertise to interpret those findings with deeper understanding. This chapter will attempt to examine the microbial succession within the plaque biofilm from health to disease, bearing in mind the susceptibility of the host, the microbial heterogeneity and the expression of virulence by

Microbial plaque has been implicated as the primary aetiologic factor in chronic inflammatory periodontal disease (CIPD, Listgarten, 1988). Studies of experimental gingivitis in man and in animal models have confirmed that a positive correlation exists between plaque accumulation and CIPD, and that plaque control reverses the inflammatory process (Lindhe *et al.,* 1973; Löe *et al.,* 1965; Page & Schroeder, 1976, 1982 Theilade *et al.,*  1966). It has also become evident, at least in relation to chronic gingivitis, that plaque mass rather than quality is the main correlate with disease severity (Abdellatif & Burt, 1987; Ramfjord *et al.,* 1968). It was initially postulated that CIPD occurred as the result of an overgrowth of indigenous plaque microorganisms (Gibbons *et al.,* 1963; Löe *et al.,* 1965; Socransky *et al.,* 1963; Theilade *et al.,* 1966). But, since many of the organisms observed in periodontal health were also observed at diseased sites (Slots, 1977), the results indicated that shifts in microbial populations rather than specific pathogens would play a role in initiating disease. Failure to demonstrate an overt pathogen gave rise to the non-specific plaque hypothesis (NSPH, Loesche, 1976), which generally assumes that all plaque is capable of causing disease. If the plaque mass is increased, irritants produced by the plaque

**1. Introduction** 

the putative pathogens.

**2. Theories proposed by early pioneers**

microbes are increased until gingival inflammation ensues.

**Periodontal Diseases** 

Charlene W.J. Africa *University of the Western Cape* 

*South Africa* 
