Periodontal diseases

Abstract

Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth (the gingiva, bone and periodontal ligament), which could lead to tooth loss and contribute to systemic inflammation. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Periodontal disease initiation and propagation is through a dysbiosis of the commensal oral microbiota (dental plaque), which then interacts with the immune defences of the host, leading to inflammation and disease. This pathophysiological situation persists through bouts of activity and quiescence, until the affected tooth is extracted or the microbial biofilm is therapeutically removed and the inflammation subsides. The severity of the periodontal disease depends on environmental and host risk factors, both modifiable (for example, smoking) and non-modifiable (for example, genetic susceptibility). Prevention is achieved with daily self-performed oral hygiene and professional removal of the microbial biofilm on a quarterly or bi-annual basis. New treatment modalities that are actively explored include antimicrobial therapy, host modulation therapy, laser therapy and tissue engineering for tissue repair and regeneration.

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Figure 1: Healthy and diseased periodontium.
Figure 2: The main stages of periodontal disease.
Figure 3: Immune responses in chronic periodontitis.
Figure 4: Clinical periodontal chart and intra-oral radiographs of a patient with chronic periodontitis.
Figure 5: Susceptibility to periodontal diseases.
Figure 6: Generalized aggressive periodontitis.
Figure 7: Decision algorithm for the therapeutic management of chronic periodontitis.

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Acknowledgements

The authors thank M. Benakanakere for assistance in developing Figure 3.

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Introduction (D.F.K.); Epidemiology (P.N.P.); Mechanisms/pathophysiology (D.F.K.); Diagnosis, screening and prevention (D.F.K. and P.G.S.); Management (P.G.S.); Quality of life (D.F.K.); Outlook (D.F.K.); Overview of Primer (D.F.K.).

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Correspondence to Denis F. Kinane.

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Kinane, D., Stathopoulou, P. & Papapanou, P. Periodontal diseases. Nat Rev Dis Primers 3, 17038 (2017). https://doi.org/10.1038/nrdp.2017.38

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