Changing periodontal paradigms: Therapeutic implications

Many paradigms concerning the epidemiology, pathogenesis, and systemic impa ct of periodontal diseases have been modified. For example, bacterial biofi lms are essential to induce periodontitis, but their mere presence is not s ufficient to initiate disease. It is also now recognized that the host resp onse to these biofilms causes most of the destruction of the periodontal ti ssues. Codeterminants that influence the clinical severity of the disease p rocess include environmental, genetic, and acquired factors. In general, th e prevalence of advanced periodontitis and the incidence of disease progres sion are lower than previously believed. However, periodontitis remains the most common chronic illness. In addition, the finding that acquired system ic diseases may predispose individuals to periodontitis, and conversely tha t periodontitis may be a risk factor for certain systemic diseases, has exp anded the scope of periodontics. These changed paradigms and their conseque nces with regard to selecting therapies are discussed in this review articl e.