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

2. 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??

3. 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.

4. 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??

5. 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

6. 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”

7. 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.

8. 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 ??? 

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