2. The prevalence of periodontal disease, the resulting high rate
of tooth mortality, and the potential for multiple systemic
health complications aggravated by chronic periodontitis
raise an important question:
Is periodontal treatment effective in preventing and
controlling the chronic infection and progressive destruction
of periodontal disease?
Current concepts of evaluating health care require a
scientific basis for treatment, referred to as evidence-based
therapy.
3. Prevention and Treatment of Gingivitis
Worldwide epidemiologic studies have confirmed a
close relationship between the incidence of gingivitis
and the lack of oral hygiene.
Löe and coworkers provided conclusive evidence on the
association between oral hygiene and gingivitis.
Thus gingivitis is reversible and can be resolved by
daily, effective biofilm removal.
4. Prevention and Treatment of Loss of
Attachment
Although periodontal therapy has been used for more
than 100 years, it is only since the mid-1970s that a
number of studies have been conducted to determine the
effect of treatment on reducing the progressive loss of
periodontal support for the natural dentition.
5. Prevention of Loss of Attachment
Löe and coworkers conducted a longitudinal investigation to
study the natural development and progression of periodontal
disease.
The results of this study are interesting. Fig. 1 shows a graphic
interpretation of the difference between the two groups.
This study suggests that without oral care, periodontal lesions
progress continually and at a relatively even pace.
6. Fig. 1 (A) Mean periodontal support of teeth of Sri Lankan tea laborers at approximately 40 years of
age. (B) Mean periodontal support of teeth of Norwegian academicians at approximately 40 years of
age.
7. Further analysis of the Sri Lankan laborers showed that they
were not all losing attachment at the same rate (Figs. 2 and
3).
Virtually all gingival areas showed inflammation, but
attachment loss varied tremendously.
Therefore under natural conditions and in the absence of
therapy, 89% of the Sri Lankan laborers had severe
periodontitis that progressed at a much greater rate than that
observed in the Norwegian group.
9. Fig. 3 Loss of attachment in untreated Sri Lankan laborers.
10. Treatment of Loss of Attachment
A longitudinal study at the University of Michigan indicated that
the progression of periodontal disease can be terminated for 3
years postoperatively regardless of the modality of treatment.
With long-term observations, the average loss of attachment was
only 0.3 mm over 7 years.
These results indicated a more favorable prognosis for treatment of
advanced periodontal lesions than previously assumed.
11. Tooth Mortality
The ultimate test for the effectiveness of periodontal treatment is
whether the loss of teeth can be prevented.
Tooth loss was significantly reduced in all patients. A study showed that
frequent subgingival scaling reduces tooth loss even when oral hygiene
is “not good” (Table 1).
The previously study at the University of Michigan After 1 to 7 years of
treatment, teeth were lost for various reasons (Table 2).
Therefore the loss of teeth caused by advanced periodontal disease after
treatment was minimal (1.15%).
12. table 1 Average Loss of Teeth During a 5 Year Period Compared With Normal Loss of Teeth in 1428 Men and
Women Ages 20 Through 59
13. table 2 Tooth Mortality After Treatment of Advanced Periodontitis in 104 Patients With 2604 Teeth Treated
Over a 10 Year Period
14. Study in a private practice, 600 patients were followed for 15 to 53
years after periodontal therapy (Figs. 4 and 5).
The majority (76.5%) had advanced periodontal disease at the start of
treatment. There were 15,666 teeth present, for an average of 26 teeth
per patient.
This study also indicated that relatively few teeth are lost after
periodontal therapy. In addition, few teeth with a guarded prognosis,
including those with furcation involvement, are lost, and a small
percentage of patients lose most of the teeth.
15. Fig. 4 Status at the start of a study of 600 patients.
16. Fig. 5 Loss of teeth in 600 patients over 15 to 53 years from nonperiodontal and periodontal causes.
17. Clinical studies have also indicated a relatively low rate of tooth
loss in patients who are involved in a supportive periodontal
maintenance program.
A study at the University of Bern found that grade 1 furcation
status was not a risk factor for tooth loss compared with no
furcation bone loss in patients treated for periodontal disease.
Risk factors for the loss of multirooted teeth included furcation
involvements grades 2 and 3, smoking, and lack of compliance
with regular maintenance therapy (Fig. 6).
18. Fig. 6 Loss of multirooted teeth during 11.5 years of supportive periodontal therapy.
19. Conclusion
The prevalence of periodontal disease and the resulting
high rate of tooth mortality have increased the need for
effective treatment.
Strong evidence now indicates that periodontal disease can
contribute to numerous health problems, including
pregnancy complications, heart disease, stroke, and
diabetes.
For patients with periodontitis, treatment effectively
prevents periodontal disease and stops the progression of
the disease.
20. In addition, evidence suggests that periodontal therapy
greatly reduces tooth mortality.
Every dental practitioner should be familiar with the
philosophy, recognition, and techniques for periodontal
therapy.
Failure to diagnose and treat periodontal disease causes
unnecessary dental problems and tooth loss and places the
patient at risk for other systemic health problems.
