Detection of high-risk groups and individuals for periodontal diseases

Though gingivitis has a prevalence of close to 100 per cent in many populations, most forms of the 'disease' are self-limiting and reversible: tooth support and function are not compromised so the public health importance of the condition is questionable. Periodontitis occurs in a number of different clinical forms which may have quite different aetiological factors and--perhaps more importantly--host predispositions. Collectively, however, these diseases result in only a minority (approximately 5-20 per cent) of most populations which have been adequately surveyed having destructive periodontitis of a 'clinically significant' degree, i.e. with pockets over 6 mm, attachment loss over 4 mm or teeth requiring extraction because of their periodontal condition alone. Indeed, current evidence shows the reasons for tooth loss, though complex, to be primarily related to caries and its sequelae (both infective and iatrogenic). Indeed, in populations without access to dental health care services most people keep most of their teeth for most of their lives. Destructive periodontitis, therefore, is not the public health problem it was until recently assumed to be. Nevertheless, a prevalence of 5-20 per cent constitutes an endemic disorder of very significant proportion. The ability to identify such individuals in advance would be a major breakthrough, as would methods for detecting the intraoral sites of those individuals susceptible to breakdown, or undergoing a phase of active and destructive periodontitis. The former may be approached by genetic and general health screening, plus measurement of immune status to relevant microbial virulence factors; the latter by microbiological, biochemical and immunological screening of oral fluids--notably gingival crevicular fluid samples on a site specific basis.