Natural history of periodontitis: Disease progression and tooth loss over 40 years

Aim To investigate the role of Epstein–Barr virus (EBV), cytomegalovirus (CMV), and anaerobic bacteria in the progression of periodontitis. Methods Eighty‐one adults with generalized moderate to severe periodontitis were randomly assigned to: oral hygiene or scaling and root planning ± placebo or polyunsaturated fatty acids fish oil. Subgingival plaque samples collected from three healthy and three disease sites at weeks 0, 16, and 28 and from sites demonstrating disease progression were analysed for EBV, CMV, P. gingivalis (Pg), T. forsythia (Tf), and T. denticola (Td) DNA using quantitative polymerase chain reaction. Results Cytomegalovirus was detected in 0.3% (4/1454) sites. EBV was present in 12.2% of healthy sites (89/728) and 27.6% disease sites (201/726; p < .0001), but was in low copy number. Disease progression occurred in 28.4% of participants (23/81) and developed predominantly at sites identified as diseased (75/78; 96.2%). CMV and EBV were not associated with disease progression (p = .13) regardless of treatment. In contrast, disease sites were associated with higher levels of Pg, Td, Tf, and total bacteria, and sites that exhibited disease progression were associated with an abundance of Td and Tf (p < .04). Conclusion Disease progression was associated with Gram‐negative anaerobic bacteria; not EBV or CMV.

Section: Discussionmentioning

confidence: 99%

Relationship between herpesviruses and periodontal disease progression

Emecen‐Huja

Danaher

Dawson

et al. 2020

“…In contrast, sites with no or minimal progression of attachment loss over time were characterized by the consistent absence of gingival inflammation over time . Overall, these observations suggest that effective long‐term control of gingivitis could prevent progressive attachment loss …”

Section: Introductionmentioning

confidence: 87%

“…Notwithstanding the reversibility of the gingivitis‐elicited tissue changes, gingivitis holds particular clinical significance because it is considered the precursor of periodontitis, a disease characterized by gingival inflammation combined with connective tissue attachment and bone loss. The evidence supporting the relationship between gingivitis and periodontitis stems from longitudinal studies, where development and progression of attachment loss was associated with greater baseline levels of gingival inflammation . In contrast, sites with no or minimal progression of attachment loss over time were characterized by the consistent absence of gingival inflammation over time .…”

Section: Introductionmentioning

confidence: 99%

Plaque‐induced gingivitis: Case definition and diagnostic considerations

Trombelli

Farina

Silva

et al. 2018

272

212

Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

“…Gingivitis is a non‐specific inflammatory condition and is therefore a consequence of sustained plaque biofilm accumulation at and apical to the gingival margin . Longitudinal studies have demonstrated that sites that do not progress to attachment loss are characterized by less gingival inflammation over time, whereas those sites that do progress have persistently greater levels of gingival inflammation . Therefore, gingivitis is a major risk factor, and a necessary pre‐requisite, for periodontitis.…”

Section: Case Definitions For Periodontal Health and Gingivitismentioning

confidence: 99%

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions

Chapple

Mealey

Dyke³

et al. 2018

Self Cite

436

383

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.