Defining and classifying periodontitis: need for a paradigm shift?

Abstract

The past two decades have witnessed a large number of proposals for the classification of periodontitis. These proposals are all founded in an essentialistic disease concept, according to which periodontitis is a link between the causes and the signs and symptoms of periodontitis. Essentialistic definitions are necessarily rather imprecise and thereby subject to multiple interpretations. Consequently, it remains unknown to what extent current knowledge regarding 'different' forms of periodontitis is based on the 'same' type of patients. However, periodontitis is a syndrome, the clinical manifestations of which may come in all sizes. Thereby, periodontitis has no diagnostic truth, just as there is no natural basis for a sharp distinction between health and disease or between 'different' forms of periodontitis. Recognition of these facts and adoption of a nominalistic approach to the definition of periodontitis is needed to provide a rational framework for the development of a classification system that meets the needs of both clinicians and scientists.

Tobacco-gene activity profile in Porphyromonas gingivalis, Filifactor alocis and Treponema denticola.

“…These include respiratory tract infections, pneumonia, tuberculosis, meningitis, sexually transmitted bacterial infections and bacterial induced periodontal diseases (14)(15)(16)(17)(18)(19)(20). The specific mechanisms by which cigarette smoking increases the risk of systemic infections are incompletely understood.…”

Cigarette smoke promotes genomic evolution in the periodontal pathogen Porphyromonas gingivalis.

“…If left untreated, bone loss will continue apically toward of the root of the tooth [31]. The destruction of the supporting tooth structure consequently causes loss of attachment resulting in tooth mobility and eventual loss of the tooth [23,24].…”

“…Proinflammatory cytokine secretion causes immediate swelling and redness of the periodontal tissues. Inflammation becomes more severe as pathogens proliferate promoting further, possible permanent tissue damage [23,24,27].…”

“…However, if left untreated, gingivitis can progress into the more severe form of periodontal disease, periodontitis. Periodontitis is characterized by irreversible inflammatory damage of the periodontal tissues such as detachment of the periodontal ligament, gingival resorption, and alveolar bone loss, eroding the supporting structures of the teeth resulting in tooth mortality and tooth loss over time [23,24].…”

Iron acquisition by the dental pathogen aggregatibacter actinomycetemcomitans.

“…The oral biofilm consists of several hundred bacterial species, but periodontal disease is often associated with a progressive succession of the predominant bacterial species in dental plaque from Gram-positive to Gram-negative (1,4). In order for bacteria to colonize and persist in a host, bacterial pathogens must be able to counteract the innate and adaptive immune system of the host.…”