Detection and management of the high risk periodontal patient

Periodontal diseases and patients at risk for progression of disease can be diagnosed on the basis of age, previous episodes of periodontal disease and loss of attachment, as detected by periodontal probing and radiographic evaluation. For early onset periodontitis, family history may be important. Microbiological evaluations are excellent determinants of disease and also appear to be probable predictors of 'at risk' patients. Reliable tests, including chairside tests, are available for the three most probable pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia. Biochemical changes, although associated with various disease states, are not yet readily measurable at the chairside, with the exception of one test that measures aspartate aminotransferase and shows promise as a detector and predictor of periodontal disease. The diagnosis and 'at risk' prediction of periodontal disease is based on a number of criteria, some of which are highly reliable and others whose reliability is either probable or unclear. These criteria are reviewed with emphasis on those that may be indicative of the patient at high risk of developing periodontal disease or progressing to a more severe form of disease.