What is periodontitis?
In some cases, recession of the marginal gingival may accompany attachment loss,
thus masking ongoing disease progression if pocket depth measurement are taken
without measurements of clinical attachment levels.
However the presence of continued bleeding on probing at sequential visits has proven to be reliable indicator of the presence of inflammation and the potential for subsequent attachment loss at the bleeding site.
The attachment loss associated with periodontitis has been shown to progress either continuously or in episodic bursts of disease activity. Although many classification of the different clinical manifestations of periodontitis have been presented over the past 20years, consensus in north America in 1989 and in Europe in 1993.
Identified that periodontitis may present in early onset, adult onset and necrotizing forms. In addition, the AAP consensus concluded that periodontitis may be associated with systemic condition such as diabetes and HIV infection and that some forms of periodontitis may be refractory to conventional therapy.
Early onset disease were more aggressive , occurred in individuals younger than 35 year old, and were associated with defect in host and were associated with defect in host defenses, where as adult forms of dieses were slowly progressive, began in the fourth decade of life and were not associated with defect in host defenses.
In addition, early onset periodontitis was sub classified into prepubertal, juvenile, and rapidly progressive forms with localized or generalized disease distributions.
Extensive clinical and basic scientific research of these disease entities has been performed in many countries, and some disease characteristics outlined 10years ago no longer stand up to rigid scientific scrutiny, in particular.
Supporting evidence was lacking for the distinct classification of adult periodontitis, refractory periodontitis, and the various different forms of early onset periodontitis as outlined by the America Academy of periodontitis work shop for the international .
It has been observed that chronic periodontal destruction , due to the accumulation of local periodontal destruction, due to the accumulation of local factors such as plaque and calculus, can occur prior to the age of 35years and that the aggressive disease seen in young patients may be independent of age but has a familial association .
With respect to refractory periodontitis, little evidence support that this is indeed a distinct clinical attachment and alveolar bone after periodontal therapy are currently poorly defined and apply to many disease entities.
In addition, the clinical and etiologic manifestation of the different disease outlined in North America in 1989 And in Europe in 1993 were not consistently observed in different countries around the world and did not always fit the models presented.
As a result, the AAP held and international workshop for the classification of periodontal diseases in 1999 to further clarify a classification system based on current clinical and scientific data.
The resulting classification of the different forms of periodontitis was simplified to described three general clinical manifestation of systemic disease .
Chronic periodontitis is considered a site-specific disease. The clinical sign of Chronic periodontitis , namely inflammation pocket formation, attachment loss, and bone loss are considered to be due to the direct, site specific effect of subginigival plaque accumulation.
As a result of this local effect, pocketing attachment, and bone may occur on one surface of a tooth while used the Ram fjord technique for measuring pocket depth and attachment loss, but the NIDR survey only included employed persons.
There by excluding major groups in the U.S Conclusions about trends in periodontal disease will not be available until a series of National survey that similarly measure periodontal disease are conducted.
However, as Douglas and fox Concluded in their study of trends in periodontal disease are seen as declining over next 30years, it would seem that a substantial proportion of this decline will be counterbalanced by the sizable increase in number of teeth persons at risk of disease.
periodontitis is periodontal destruction that become clinical significant around
adolescence or early adulthood. The disease has been classified in to two types
localized and generalized .
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