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I've heard the statistics that 75% of Canadians may have periodontal disease, but in my practice I don't see that many patients with clinical signs; why the discrepancy?
 
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I've heard the statistics that 75% of Canadians may have periodontal disease, but in my practice I don't see that many patients with clinical signs; why the discrepancy?

 

Periodontal disease is a four-stage disease.

 

During the first three stages (referred to as gingivitis) the disease may be present without apparent symptoms such as inflammation, bleeding and soreness.

Stage 1, initial lesion: Periodontal disease begins with an initial lesion in the gingival tissues adjoining the tooth surface. This lesion, which can appear within two to four days of biofilm accumulation, is characterized by increased blood supply and white blood cells. There may be a slight change in gum tissue colour.

Stage 2, early lesion: If plaque or biofilm accumulation is not reduced, more white blood cells can infiltrate gingival tissues, leading to the early lesion stage. Inflammation may be evident in the margin of gingival tissues.

Stage 3, established lesion: Connective tissue near the junctional epithelium begins to disintegrate and recession may become apparent. Established lesions may remain at this stage for decades or they may progress to a more advanced stage. Recession may advance slowly and inflammation may not be pronounced.

Stage 4, advanced lesion: Visible symptoms arise: periodontal pocket formation, inflammation, sometimes gingival ulceration and destruction of the alveolar bone and periodontal ligament.

Dental professionals need to be proactive in identifying the early stages of periodontal disease because biofilm can quickly move from a healthy to a harmful state. Localized aggressive periodontitis, for example, which is characterized by the severe loss of alveolar bone, can affect young people who are otherwise healthy and who have little dental plaque or calculus.

Detecting the first three stages of periodontal disease therefore requires:

• probing to identify and count the number of bleeding points and pocket depth change; doing a PBS to see if there is bleeding when the gums are touched before scaling.

• monitoring changes in the clinical attachment level; and

• using disclosing solutions to detect the amount of biofilm present;

• initiating a microbial analysis of the patient's oral cavity to identify the type and volume of pathogens and to facilitate the selection of appropriate treatment.

By keeping your patients' oral tissues disease-free you can help to reduce their risk of cardiovascular disease, diabetes, dementia, pneumonia, cancer and numerous other health problems.