CONTROVERSIES IN PERIODONTICS “When a thing ceases to be a matter of controversy it ceases to be a matter of interest”. William Hazlitt.

Infection /host response Pathology Clinical features Infection /host response DISEASE??? Classifying periodontal diseases – A long standing dilemma Chronic Periodontitis CONSTELLATION OF DISEASES ? smoking Microorganisms Oral hygiene Environment Host Stress MICROBIOLOGICAL FACTORS?? POST-GENOMIC ERA Diabetes Classifying based on GENETIC FACTORS??

periodontitis and smoking are associated with similar health risks. periodontitis–systemic disease associations have not been identified among never-smokers. periodontitis and smoking are associated with similar health risks. conflicting study results can be explained in terms of statistical adjustment for tobacco smoking. dental infection elimination through complete tooth removal, unlike smoking cessation, does not reduce health risks.

DO WE NEED Miller-PLUS classification of gingival recession? Usefulness To distinguish between recessions related to toothbrushing trauma (class I & II) from those caused by periodontal disease (class III & IV) Exhaustiveness ?? Because it doesn’t consider all cases of recession Simplicity ??? As it considers many factors : MGJ, Soft and hard interproximal tissues, gingival margins of adjacent teeth, teeth malposition, tooth loss Disjointness ??? Class III & Class IV can be identified only if there is adjacent tooth Palatal recessions??

Spontaneous vertical root # ENDO PERIO Dilemma in accurate identification of lesions. Spontaneous vertical root # If the pulp is vital during probing If the pulp is non-vital during probing ACQUIRED DEFORMITY PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESION Therefore the classification is not helpful in prognosis and devising the proper treatment plan

Prevention of emergence of resistant strains Advantages Prevention of emergence of resistant strains No prescription of arbitrary antibiotics Which antibiotics? Which bacteria? Disadvantages Limitation of drug effectiveness Problems in sample collection and transport specific species may not indicate disease state or activity Unable to detect “all pocket colonizers”

Finding genetic risk factors for periodontal diseases: is the climb worth the view? Assessments of the fundamental biological processes that lead to periodontal tissue destruction. Such tests if administered at an opportune time, subclinical disease could be detected and appropriate environmental or genetic therapies could be administered. The multiple genes with multiple interacting effects could make the interpretation of genetic effects complex. These effects would be further complicated by the environmental etiological agents.

Putative periodontal pathogens positive in both states Who is my true friend? In health In disease On plaque accumulation On sensitive microbiological testing Putative periodontal pathogens positive in both states Which microbial species is beneficial ??? 

So, will periodontists be able to take advantage of genetic information for the improved care of their patients?