Periodontal disease epidemiology – learned and unlearned?

Abstract

The notion of periodontal disease being the major cause of tooth loss among adults was rooted in the focal infection paradigm that dominated the first half of the 20th century. This paradigm was established largely by personal opinions, and it was not until the development of periodontal indices in the mid-1950s that periodontal epidemiology gained momentum. Unfortunately, the indices used suffered from a number of flaws, whereby the interpretation of the research results took the form of circular reasoning. It was under this paradigm that therapeutic and preventive intervention for periodontal diseases became entirely devoted to oral hygiene, as poor oral hygiene and older age were understood to explain nearly all the variation in disease occurrence. In the early 1980s, studies appeared that contradicted the concepts of poor oral hygiene as the inevitable trigger of periodontitis and of linear and ubiquitous periodontitis progression, whereby periodontal epidemiology was led into a relatively short-lived high-risk era. At this time, it became evident that old scourges continue to haunt periodontology: the inability to agree in operational clinical criteria for a periodontitis diagnosis and the inability to devise both a meaningful and a useful classification of periodontal diseases based on nominalist principles. The meager outcome of the high-risk era led researchers to resurrect the focal infection paradigm, which is now dressed up as periodontal medicine. Unfortunately, these developments have left the core of periodontology somewhat disheveled and deserted.

Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

“…As periodontal breakdown (loss of attachment) is usually accompanied by gingival inflammation, it was thought that gingivitis (caused by bacteria) would invariably result in periodontitis if left untreated. This paradigm became dominant in periodontology for almost half a century [Baelum and Lopez, 2013] and was DOI: 10.1159/000488948 the explanation for the claim that periodontitis is an infectious disease. For decades microbial studies have therefore searched for the microorganisms involved in, and thought to cause, periodontal breakdown [Dahlen, 1993;Haffajee and Socransky, 1994;Socransky and Haffajee, 1994;Loesche and Grossman, 2001].…”

Is periodontal disease a public health problem?

“…17 They identify four main features of what they termed the periodontal diseases. These are that: clinical attachment loss of 1 mm or greater is highly prevalent even in very young subjects; within a given population, the prevalence of attachment loss, the extent of attachment loss and the severity of attachment loss increase with age; within a given age group, the distribution of the extent and severity of destruction tends to be right-skewed to such a degree that a minor fraction of the subjects carries the major burden of destruction in the group; and, within a given population, the intra-oral pattern of distribution of periodontal destruction is rather distinct and corroborates the molarincisor pattern originally considered characteristic for juvenile periodontitis.…”

Epidemiología de las Enfermedades Periodontales en el Uruguay. Pasado y presente

“…The paradigms on etiopathogenesis and the available diagnostic instruments determined them (22) . The…”