[Periodontal disease and prevention in children and adolescents]

Clinical and epidemiological studies have shown that: 1. Bacterial plaque which accumulates around the teeth is responsible for chronic periodontal inflammation. From adolescence on, this inflammation is almost universal. 2. Gingivitis prepares the periodontitis, which is characterized by a migration of the epithelial attachment, pocket formation and progressive bone loss. 3. Calculus is formed by plaque calcification. Its rough surface allows bacterial retention and proliferation in contact with the epithelial covering. 4. The mechanisms of host resistance to parasitic plaque are mostly unknown. This resistance is variable and seems to decrease with age. 5. Periodontal disease in children and adolescents is a real problem in preventive medicine, because of its immediate or remote consequences on tooth loss. Thanks to fluoride, the prevention of dental caries is quite effective; the prevention of periodontal disease is on the contrary much more difficult. Mechanical removal of plaque is tedious and must be done again and again; however, it is not logical to separate prevention of caries from that of periodontal disease. Information of the public at large on oral health is of utmost importance, as well as a good cooperation of the teachers in preventive programs for schoolchildren. Every health department or service should try to apply the following measures: -Permanent employments for "school dental nurses" should be created, on a part-time or full-time basis. They should take care of the organisation and supervision of oral health programs. -In each school dental service, a dentist should be responsible for teaching the theoretical and practical aspects of periodontal prevention. -Caries reduction obtained by fluorides is no excuse to reduce the "treatment staff". This staff should be devoted to prevention at large and to refreshing courses. In a young population with regular supervision, prevention of periodontal disease can meet with considerable success. Initial periodontal disease is reversible: it is possible to avoid the degradation of gingivitis in progressive periodontitis, and this helps maintaining dental and periodontal health throughout life.