Periodontal health and disease in young people: screening for priority care

Gingivitis is the most common chronic disease affecting young people. Almost all teenagers exhibit gingival lesions in the interproximal areas of posterior teeth. Gingivitis is caused by supragingival bacterial plaque which contains more than 165 species and subspecies. No single organism or group of bacteria can be directly implicated in the development of gingivitis. Periodontitis occurs before 20 years of age, is also first found in the interdental areas of posterior teeth and is preceded by gingivitis. It progresses slowly through the decades of adult life with varying rates in different individuals and teeth within the same mouth. Subgingival plaque contains more gram-negative, anaerobic organisms and more motile bacteria than supragingival plaque. Progression of periodontitis coincides with the occurrence of certain Bacteroides species, fusobacteria and other anaerobic motile rods as well as spirochetes. However, at this time the concept of specific pathogenicity cannot be applied. Rapidly progressing localized or generalized periodontitis is characterized by the rate of periodontal destruction and usually occurs in less than one per cent of juveniles. These patients exhibit increased prevalence of Actinobacillus actinomycetemcomitans and abnormalities in neutrophil function. At present, simple clinical screening tests that can predict who will and who will not suffer from chronic periodontitis, that can provide early identification of high risk patients or forewarn the development of juvenile periodontitis are non-existent. Research in this area is seeing significant progress and several technologies have shown promise. While awaiting new screening methodologies, the clinician must continue to rely on periodontal probing, radiographic techniques, visual inspection and clinical acumen as the main means of periodontal diagnosis.