Lost in the pocket: the current status of periodontal diagnosis

A number of "state of the art" diagnostic procedures based on data generated by technological advances in microbiology, immunology and molecular cell biology have been developed to assist the dentist in identifying patients at risk of acquiring periodontal disease or who are currently experiencing loss of periodontal attachment. This paper challenges the assumptions upon which these tests are based and presents an alternative hypothesis of the natural history of periodontal disease. This hypothesis considers the microflora of the oral cavity and the inflammatory response of the host to be part of an ecosystem which has evolved over many years of interaction and adaptation between unicellular and multicellular organisms. These interactions have resulted in the selection of biological strategies that provide intrinsic benefits to the host and to the microorganisms comprising the indigenous flora.