NEW CLINICAL DIAGNOSTIC STRATEGIES BASED ON PATHOGENESIS OF DISEASE

The pathogenesis of periodontal tissue destruction involves the orches trated sequential activation of several components of the host respons e, each of which have the potential for providing diagnostic informati on regarding the health or disease status of the periodontium. These e vents include the bacterial triggering of serum components, the releas e of vasoactive compounds, the recruitment of inflammatory cells, the activation of phagocytes, the local secretion of immunoglobulins and i nflammatory mediators, as well as connective tissue remodeling. For pu rposes of diagnosis, much attention has been directed toward the measu rement of local levels of specific byproducts of the pathogenic proces s either within the tissues or in the adjacent crevicular fluid. These are site-directed assessments of the local concentration of these byp roducts, and with the important exception of antibody levels, very few byproducts of the periodontal pathogenic process have been studied on a systemic level, However, since the risk associated with periodontal disease progression is primarily patient-based and secondarily site-b ased, there is an increasing need to identify patients at risk for int ervention strategies. Furthermore, there are substantial data that per iodontal diseases are specific infections that occur in an appropriate ly susceptible host. The expression of periodontal disease has a stron g genetic component, which presumably defines the host's response ther eby affecting susceptibility. For this reason, there is increased inte rest in defining those elements of the host response which result in s usceptibility to disease. The ultimate objective of a diagnostic strat egy is to identify patients who are potentially at risk for acquiring disease to enable preventive measures.