Determination of periodontal disease activity

The determination of disease activity has a direct impact on therapeutic measures in periodontics. Evaluations that may indicate disease activity have been reviewed under the topics of traditional evaluations, gingival crevicular fluid contents, tissue changes, circulating factors, and sulcular microbiota. The traditional methods, such as probing, radiographs, and clinical indices, were static evaluations that had limited validity in determining disease activity. When used in longitudinal tests, these methods may be used retrospectively to detect disease activity. Evaluation of the contents of gingival crevicular fluid has promise as a noninvasive method of determining tissue changes in the periodontium. To date, none of the crevicular fluid constituents has been a reliable indicator of disease activity. Tissue changes in the periodontium are important in understanding the disease processes but have had limited value as indicators of disease activity. The ability to determine disease activity through identification of substances or changes in the systemic circulation would prove quite useful to the clinician. Although some reports found lymphocyte transformation indicative of active disease, others had conflicting results. Finally, examinations of sulcular microbiota provided evidence suggesting that active periodontal disease was associated with specific groups of pathogens and with elevated counts of motile organisms. The evaluation of such pathogens and motile organisms currently shows the most promise for determining periodontal disease activity. However, long-term assessments and further clinical trials are necessary before this type of evaluation can be widely accepted. It is hoped that such studies will enable the clinician to predict the natural history of active and inactive periodontal disease.