As we’ve seen well-established in literature,1 periodontal diseases today affect a significant percentage of U.S. adults, with nearly 47% of U.S. adults (70% aged 65 and older) having periodontitis per researchers.2 Periodontal disease is multifactorial and, while periodontal research continues to examine the involved host factors and bacteria, caregivers focus on the preventive measures for high-risk patients. With a combination of in-office periodontal debridement3 and chemotherapeutic agents, dental professionals have valuable treatment alternatives to manage periodontal disease.
Focus shifts now to the etiology of periodontal disease. In her presentation, “Working Collaboratively with the Dental Hygienist in Periodontal Treatment Planning,” Dr. Christine Karapetian, a Board Certified Specialist in Periodontics and Implantology, discusses the etiology of periodontal disease, explores the benefits of teamwork and interdisciplinary care, and outlines the roles of the dental hygienist and dentist in diagnosis and periodontal care. Here’s what she had to say on the factors in diagnosis of periodontal disease:
Gram-Positive and Gram-Negative Bacteria
In the oral cavity, two types of bacteria are present: gram-positive and gram-negative. Ideally, we would want the gram-positive bacteria to be higher than gram-negative. When gram-negative bacteria begin to proliferate, patients who are at high risk of periodontal disease suffer an immune response. The immune response begins to cause destruction of the periodontal tissue, bone, and gingiva. The main etiology of periodontal diseases lies in this bacterial plaque of a susceptible host.
Calculus and Plaque – As we know, effective control of the plaque biofilm depends on intervention by both the dental professional and the patient through his or her at-home treatment.
Smoking – Unless the patient is willing and follows through on quitting, patients who are smokers will continue to have a high risk of periodontal disease.
Diabetes – People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.4
Open Contact and Malposition Teeth – With orthodontic treatment and restorations, mismatched, crooked teeth can easily be fixed, closing their gaps to prevent periodontal disease from being more prevalent.
Utilizing a comprehensive periodontal risk assessment, the practitioner can establish an accurate diagnosis, provide an optimal treatment plan, and determine appropriate maintenance programs. Dentists can start by using an extraoral/intraoral or a head and neck exam, leading to treatment in the oral cavity. Checking the teeth for any informalities, eruptions, caries, and open margins, while also keeping your full-mouth x-rays handy to guide you, can help examine what risk factors are present in the patient.
Check the patient’s periodontal health and be sure to check off these questions:
How well is he or she maintaining proper oral hygiene (e.g., brushing, flossing, rinsing)?
How much calculus or plaque is accumulated?
Is there inflammation present? Bleeding on probing? Clinical attachment loss? Recessions? Furcations and mobility?
What is the patient's occlusion?
After establishing your comprehensive dental exam, you’ll be better able to recognize the etiology of the specific patient’s periodontal disease. It is also important to update and assess risk factors for each patient on a regular basis, as some of these factors are subject to change throughout the patient’s life. While searching for these factors, the etiology of periodontal disease can help practitioners make sound judgements on what the best course of action will be.
 Genco RJ, Williams RC, eds. Periodontal Disease and Overall Health: a Clinician's Guide. Yardley, PA: Professional Audience Communications; 2010.
 Eke PI, Dye BA, Wei L, et al. Relevance of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012;91(10):914-920.
 Loesche WJ. Treating Periodontal Diseases as Infections. Dimensions of Dental Hygiene. http://www.dimensionsofdentalhygiene.com/2008/06_june/features/treating_periodontal_diseases_as_infections.aspx. Published June 2008. Accessed September 29, 2016.
 Diabetes and Periodontal Disease | Perio.org. Perio.org. https://www.perio.org/consumer/diabetes.htm. Accessed October 24, 2016.