January 11, 2018
by Zahra Dorna Mojdami, HBSc, DDS; Michael Glogauer, DDS, Dip Perio, PhD; Amir Azarpazhooh, DDS, MSc, PhD, FRCD(C)
The most common chronic inflammatory conditions worldwide and collectively the most common diseases known to mankind, are inflammatory periodontal diseases.1 Periodontal diseases include gingivitis, where the inflammation confined to the gingiva is reversible with good oral hygiene, and periodontitis, an extension of the inflammation that results in tissue destruction and alveolar bone resorption.1 Periodontitis is very common with 10-15% of adults being afflicted with severe periodontitis and 40-60% being affected by moderate periodontitis.2 Several forms of periodontitis have been recognized; however, the predominant category is chronic periodontitis (CP) which remains the number one cause of tooth loss in adults worldwide.3 The goal of periodontal diagnostic tools and procedures is to provide useful information to the clinician on the periodontal disease type, location, and severity. This information will serve as the basis for treatment planning and monitoring of disease.4 Traditional periodontal clinical diagnostic parameters include probing depths, bleeding on probing, clinical attachment levels, plaque index, and radiographs.5 The strengths associated with these traditional tools are that they are easy to use, cost-effective, and are relatively non-invasive.5 However, these traditional diagnostic procedures are limited in that only disease history, not current disease status and activity, can be assessed and identified.5,6 For example, clinical attachment loss readings by the periodontal probe and radiographic evaluation of alveolar bone loss measure damage from past episodes of destruction and require a 2 to 3 mm threshold change before a site can be identified as having experienced a significant anatomic event.5 Even in instances when patients’ treatments are monitored over time it can be difficult to use these clinical parameters to make a definitive periodontal diagnosis.5 As another example, does a patient who has been treated with non-surgical periodontal treatment and now has several sites with residual probing depths that bleed on probing still have periodontitis that requires further active therapy or surgical treatment, or is the condition stable and the disease in remission?7 Moreover, other limitations such as the difficulty in precisely duplicating the insertion force, probe placement and angulation exist.8 Radiographs, a key factor in determining the severity of periodontitis and bone-related damage, have limited sensitivity and only reveal change in bone after 30% to 50% of bone loss has occurred.8 Furthermore, radiographs cannot be taken at each visit due to excess radiation exposure to the patient.8 Advances in oral and periodontal disease diagnostic research are consequently moving forward toward methods whereby periodontal diagnosis and risk can be identified and quantified by measures that are objective7, minimally invasive, less technique sensitive, less time consuming and that are able to identify active and potential periodontal disease. New developments in periodontal diagnostic research will be discussed below.