Talk:Periodontitis

European vs. Mediterranean descent
"In Israeli population, individuals of Yemenite, North-African, South Asian, or Mediterranean origin have higher prevalence of periodontal disease than individuals from European descent."

This sounds odd, since there are many Europeans of Mediterranean descent (people from Spain, southern France, Italy, etc.). So, the two origins do not exclude each-other.--95.89.27.110 (talk) 20:27, 12 March 2013 (UTC)

Vitamin C

 * As the links I added indicate, there are both bodies of scientific evidence that casts doubt on the effectiveness of routine cleaning or the frequency at which it should occur (the Cochrane review of 2005) and also then consideration as to the appropriateness of providing this as a service to patients (UK National Institute for Health and Clinical Excellence)
 * I'm sure there are differing views taken by/between various dentists, but the original version seemed to be making a point of view, rather than adhering to WP:Neutral point of view policy.
 * If you wish to add a comment about dentists disagreeing with this meta-analysis or decision on service provision, then fine provided it is referenced. However I note the BBC news report quoting "Dentists have welcomed the move as 'common sense'".
 * So back to the question you originally raised re deletion of passages. Looking between the edits, the only details removed (rather than rearranged or joining of sentences) seemed to be:
 * "Gingivitis can be stalled if a patient receives regular gum cleanings from his or her dentist every 3-6 months." - POV, now covered by new paragraph of "Whilst regular routine dental checks and gum cleanings are proposed as helping to prevent the onset of the condition, there is little evidence either to support this or the intervals at which this should occur.[1] Instead it is advocated that the interval between dental check-ups should be determined specifically for each patient.[2][3]"
 * "The cleanings are designed to disrupt and clean out bacterial plaque and toxins from below the gumline. This temporarily removes the bacterial plaque and toxins (the causes of the gum inflammation). But after 3-4 months the bacteria tend to grow back and have to be cleaned out again by the dentist." - temporary effect of cleaning is already covered by the rearranged text now found as the middle paragraphs of 'Prevention' and 'Treatment of established disease' sections.
 * "It is important for all people to have regular gum cleanings every 3-6 months from their dentist. Otherwise continued inflammation (gingivitis) can over the years lead to loss of bone around the teeth (periodontitis)." - as per points raised for (1)
 * "Once bone breaks down around the jaws, it is very difficult or impossible to build it back." - Ok I agree this was lost, but surely what is lost is lost. the consequences are set out in the 'Aetiology' section (i.e. eventually tooth loss) and the difficulties of building up via bone grafting is mentioned at the end of 'Treatment of established disease' section. Please note a citation would be useful here (i.e. so people can look up how difficult or what the "mixed success" rates might be).
 * re cavitrons "and gives off a high-pitched whine when used." - I missed this out partly because it seemed irrelevant and also it (in the restructured version) seemed to divert from describing what is trying to be achieved.
 * "Fortunately, the science exists to routinely catch and prevent this catastrophic loss of teeth years before it actually happens, as long as the patient is regularly examined every 3-6 months by a dentist for bone loss and also dental decay." - I disliked the initial English and there are again issues of NPOV, see (1). The first clause is perhaps acceptable if patients having appropriate individual recall-interval checks are found to have onset of disease and action then taken (which is largely oral hygiene measures). The second clause seemed breach of NPOV for reasons previously given.
 * I think this covers all the dropped sentences - in summary much duplicated itself, or became apparent as already being covered once I had restructured the article. The insistence on 3-6month routine checks as preventing seems POV and I tried to balance this past practice (I agree dentists used to advocate 6 monthly checks here in the UK too) with the latest summary of evidence and response from the NHS advisory body on good clinical care. With "the Faculty of General Dental Practitioners, worked on the new guidelines", this surely is the majority UK dentist viewpoint ?
 * You commented "I would be more comfortable if a dentist or specialist edited dental topics". I would point out that no one or no group own articles, as the Main Page states "... Wikipedia, the free encyclopedia that anyone can edit."
 * Any editor can edit any article.
 * Of course specialists are particularly welcome at wikipedia as they have a body of knowledge that they can help contribute with. In addition they can help ensure articles comprehensively cover topics, given they have a broad knowledge of a particular field.
 * However any editor can contribute facts and description to a topic; provided of course they can cite sources for any claims made. Likewise any editor may copyedit an article for better English, or for better encyclopaedic writing or for Wikistyle.
 * There is a danger (which I too am guilty ) for "specialists" to write articles like undergraduate/post-graduate textbooks or instruction manuals. Someone outside of a field may be helpful to a topic to help ensure it meets good standards: firstly as appropriately targeted for the non-specialists and secondly in style for a general encyclopaedia - although what an encyclopaedia wikipedia is :-)
 * Please do feel free to respond to any of these points :-) Yours David Ruben Talk 02:35, 11 May 2006 (UTC)

POV challange
The edits here now returns article to stating that ideally 3monthly checks and cleaning should be performed. Removal of previous qualification to this previous policy, now makes footnotes 1 & 2 (NICE guidelines and BBC news reports) seeing to act to verify this claim, yet they quite clearly report the discontinuation of even routine 6 monthly checks to possibly as long as every 2 years. This seems to be a POV distortion.

PS. re edit summary coment "Physicians who have no formal dental training should generally avoid making major edits of dentistry-related topics. There is not much technical overlap between medicine and dentistry" no one owns articles - I can read and cite BBC News stories that report agreement by the British Dental Association with the "NICE recommends the interval for adults should be between three and 24 months" as well or as badly as those with "formal dental training". Please WP:assume good faith.

You have made some good improvements, particularly with introduction description, although I have made a few minor changes to the Englsih (improvements I hope). However I general prefer to follow the One revert rule, so will allow you to comment re the POV issues I mention above, rather than directly now trying to revert back :-) David Ruben Talk 04:12, 11 May 2006 (UTC)


 * The the idea, in the UK, is to replace the idea of fixed 6 monthly checks that has been present since the NHS started to a sliding scale of check intervals depending upon each patient's needs (every 3 months if establised dental problems in childern, to 24 months for healthy adults). From The Times October 27, 2004 I quote the following:
 *  Ralph Davies, chairman of the representative body of the British Dental Association, which speaks for more than 20,000 dentists, said the changes were a victory for common sense. “The BDA has always held that the frequency of dental check-ups should be based on the individual patient, not a ‘one-size-fits-all’ system,” he said. The American Dental Association advises only “regular” dental check-ups, while the Centers for Disease Control and Prevention, in Atlanta, specifies that “the frequency of routine dental visits should be based on individual need”.
 * Again, I think recent edits made some further good improvements to the article, but I have had another go at rewriting some parts of the Prevention section, in light of above points. David Ruben Talk 01:45, 13 May 2006 (UTC)

Does Listerine belong here?
I understand that mouthwashes with alcohol make the problem worse by irritating the tissues bordering the tooth. From looking at the ingredients in Listerine, it appears formulated for it's sensation properties than for it's clinical purposes. (ingredients include Alcohol, Caramel, Eucalyptol, Menthol). It therefore does not deserve a mention on this clinical page. In general, mouthwashes with Chlorohexidine Gluconate are prescribed and available over the counter for gingivitis and peridontal disease. An example of this type of preparation is Corsodyl.
 * On the contrary, Listerine has the ADA Seal of Acceptance for its anti-plaque properties. Plaque is the primary etiology of periodontitis.  Thus, Listerine should be mentioned.  DRosenbach  ( Talk 00:17, 6 August 2007 (UTC)
 * Sorry, common sense would say that it is preferable to use any substance that does not irritate tissue. I would, however, like some study(ies) cited where use of these mouthwashes, along with good oral hygiene actually stopped periodontal disease.  Was there a control group with good oral hygiene and no mouthwash?  Where did the funding for the study come from?  Therefore, I would like to follow the following sentence with -citation needed-
 * quote: "Chlorhexidine gluconate based mouthwash or hydrogen peroxide in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis." I am delighted to know this, and would just as much like to read the results of a study.--Campoftheamericas (talk) 08:50, 30 January 2008 (UTC)

Some Small Points
I am a total noob at this wikipedia thing, but I have some opinions that need to be expressed. Whether or not these items are deemed meritable I will leave up to the members and readers. Firstly, there is an issue with nomenclature in this article. I feel it is important to point this out as it lead to considerable confusion for me as a dental undergraduate, and therefore I feel it may lead to confusion in others (I realise this is an encyclopedic article and not a textbook article). IMHO, the term periodontal disease is not the same as periodontitis or pyrrhoea. Periodontal disease is an envelope term used to describe and group diseases of the periodontium, that is the supporting tissues of the teeth (including cementum, periodontal ligament, bone and gingivae). Therefore, periodontitis in all its forms is a subset of diseases under the heading of periodontal diseases, as is gingivitis, ANUG, ANUP, primary herpetic gingivostomatitis and others. I feel that this article is considerably too narrow in scope to be called 'Periodontal Disease'. I know I am probably splitting hairs.

This is where criticism of this article gets difficult, because the profession of dentistry continues to re-evaluate the nomenclature and classification of periodontal diseases (it seems there is a new system every bloody week :D). Because this article is encyclopedic and not scholarly in scope, lines must be drawn and boundaries made in order to make information accessible to the average reader. I feel that Wikipedia tends to confusingly sit on both sides of the fence on this issue. The scope of this article needs to be adjusted if it is to be considered encyclopedic and not scholarly, and must not pass itself off as scholarly when it is not written by a trained and educated academic of that particular subject. I refer in particular to the description of vertical and horizontal bony defects. This belongs not in an encyclopedic article but in an undergraduate textbook.

Because this article is encyclopedic and not scholarly, I am opposed on ethical grounds to including overly detailed information about treatment and diagnosis as this may lead the untrained individual to (possibly) incorrect self-diagnosis and self-prescription. If this information is to be retained, the article should contain a caveat of some sort, possibly along the lines that this information does not substitute advice from a trained professional in a clinical setting. For ethical (and legal) reasons, I personally would never engage in giving information about treatment on the internet, over the phone, via mail or any other means unless I had previously seen or was currently seeing that patient in a clinical setting. Just my opinion.

Thirdly, while 'pocket' may be a misnomer in lay terms, in the dental profession a pocket is a pathologically affected site, clinically and histologically distinct from a healthy 'sulcus'. Just thought that that might clear up some confusion.

Lastly, while I understand that Wikipedia articles are not owned by any one person, I have a tendency to agree with Mamounjo about the use of knowledge from trained dentists and specialists. I also agree with you that anyone can read and cite articles, but it is only people who are trained in the interpretation of scientific articles that should really use them in this context. General medical practitioners no doubt have an understanding of the basis of diseases that happen in the mouth, but dentists and specialists are likely more aware of the peculiarities of the oral milieu in both a clincial and (patho)physiological sense. Nowhere is this more acutely highlighted than in periodontal disease, which, I imagine is moderately understood by even a significant portion of the dental profession (IMO!!) in a pathophysiological sense because it is one of the most highly complex and unique pathophysiological processes in the body, which is not fully understood by science as of yet. Health care professionals are interpreters in the main; we interpret sign and symptom to produce a diagnosis which in turn influences treatment planning and prognosis. Each health care professional is trained to interpret a particular set of signs and symptoms. While these sets may overlap to a degree (for instance dentists need to know quite a bit about general medicine, as I'm sure doctors need to know a good bit about the mouth), there are certain portions of these sets that are best interpreted by the professional trained and more experienced in their interpretation. No offense. I would hope no-one would expect me to diagnose an ingrown toenail or other things of that nature! I would know it was an infection, have an idea of the treatment but I really wouldn't like to have a go at definitive diagnosis or treatment. By the same token, each professional should be trained and be experienced in the interpretation of scientific and scholarly articles in terms of quality and merit in their own area of expertise. As such, this is a criticism of Wikipedia as a whole and not one particular contributor. Its one inherent drawback, I suppose!

I do feel that this article is quite good for what it is, it just needs to make up its mind - scholarly or encyclopedic. 8 August 2006 (UTC)


 * Thank you for interesting and well argued points. Issues of nomenclature seem, to myself a non-specialist, as you set out. Certainly term as most commonly encountered by non-specialists is as currently used in article vs. being more umbrella term to also includes herpes infections etc - which approach would be correct for the article is clearly matter for those with greater knowledge of overall field of dentistry. I note though that "a new system every bloody week", so it might prove challenging to decide what to state as the general dental consensus and to WP:Cite to WP:Verify whatever position is therefore taken.
 * re "information about treatment and diagnosis" - I agree care must be taken as to not seeming to give professional healthcare advice, but that does not exclude giving some overview of the typical range of approaches that may be taken, perhaps with suitable generally pointers as to what aspects of a condition affect decisions as to which of several treatment options to take (e.g. for coronary angioplasty vs. open heart bypass grafting: issues of patient suitability to undergo general anaesthetic & rigors of operation, number/length/extent of blockages, invasiveness of procedures vs. interval before having to repeat).
 * As for "caveat" or disclaimers, this gets raised at intervals on medical topics too, but it is repeatedly pointed out that each page already has at the bottom a 'Disclaimers' link to General disclaimer which includes "Not professional advice" section. But yes you are quite correct to remind us of these principles in considering our editorial style of writing.
 * I understand the points you raise in your most polite comment about non-specialist input to article, and quite take them as "criticism of Wikipedia as a whole and not one particular contributor".. Yes ideally a well-written encyclopaedic article is written first time by a specialist, to a quality that needs no amendment. However the lay editor can help with modifying the level to pitch the explanation at (academics good at teaching undergraduates but may either over or under simplify for the rest of us), indicate where a specialist's assumption of a fact being universally accepted is not self-evident to a lay reader and that verification and additional sources requested. If you look at the overall changes in article between my 1st and last edits to the contents (here), you will see considerable wikifying of the mark up as per the pre-existing wikify tag (i.e. proper section headers) and correction of the dental information itself - namely reversion of unsubstantiated POV that "It is important for all people to have regular gum cleanings every 3-6 months from their dentist" and "patient is regularly examined every 3-6 months by a dentist" which I knew was some 18months out of date for UK practice. This was not my POV but that of the NICE guidelines for "interval between dental check-ups should be determined specifically for each patient between every 3 to 24 months" and this had been accepted by the 18,000 dentists of the British Dental Association – I was merely deferring to NICE/BDA "portions of these sets that are best interpreted by the professional trained" :-)
 * re "scholarly or encyclopedic" - yes constantly a difficult decision to make - clearly must at least be encyclopaedic, but to what level also scholarly ? Too high a level obviously ends up with minutiae being debated and large numbers of papers having to be cited. I tend to feel the level should be pitched for high-school students to gain a basic overview of topics and with enough specifics for an undergraduate to feel that a suitable outline to a topic has been covered. (i.e. Masters or PhD level not required) David Ruben Talk 01:49, 8 August 2006 (UTC)

Thank you, David, for your timely and balanced response. All very fine points. As I went to bed last night, I was thinking long and hard about the points that I raised and realised as a Wikipedia newbie, I had probably missed similar points being brought up a thousand times before. I appreciate your patience.

I have a tendency to agree with you in terms of the level of detail to aim for in these types of articles. Reading the article again, it seems that a good balance has been achieved. Upon my initial reading of the article, I found it slightly frustrating, as I was used to writing academic/scholarly essays which I always started on the premise that the reader knows nothing. That way, I would leave nothing out.

Periodontics in particular is very difficult to reference. Prof. Noel Claffey, who is the Dean of the Dublin Dental School and former Professor of Periodontology at Loma Linda (I think) used to lecture us about the history of periodontology stating that until about 20 years ago, there was very little properly executed research and that two periodontists had two differing opinions. I think he performed a study on inter- and intraclinician variability on examination, diagnosis and treatment planning for various sites in multiple patients and came up with very discouraging results. In terms of classification and nomenclature, Annals of Periodontology, Vol. 4 has everything and is AFAIK up to date. Dr-G - Illigetimi nil carborundum est. 14:39, 10 August 2006 (UTC)


 * Well, I believe periodontitis should indeed not redirect here, and periodontal disease is indeed an umbrella term, e.g. .--Steven Fruitsmaak (Reply) 18:20, 11 December 2006 (UTC)


 * Absolutely periodontal disease and periodontitis should be different articles. Periodontitis is a form of periodontal disease and is also the proper name. Periodontal disease should be an article of all diseases affecting the periodontium. Thus, this article should be moved to Periodontitis, and a new article describing all periodontal diseases should be written here. - Dozenist talk  02:47, 12 December 2006 (UTC)
 * Per the above discussion, I've moved this page to Periodontitis, leaving a redirect at Periodontal disease. I guess now somebody should write an article there, about periodontal disease in general. -GTBacchus(talk) 03:28, 18 January 2007 (UTC)

My name is Mitchell Kaufman, DDS. I am a practicing periodontist for over 15 years. I received my post graduate training from Columbia Universty. I am sensitve to the fact that this is an encylopedia article and not a text book article written for professionals. However, some form of peer review is necessary when disemminating this type of information to the public. Accuracy is always important if this encylopedia is to remain legitimate. The points made by the undergraduate student are succinct. I am of the opinion that this article is best left to an expert in that particular field of study. I appreciate the authors efforts. He has written a good article to the best of his knowledge and ability. If you would like to visit a website that I feel would be helpful, follow this link. I would be happy to edit the article without getting to technical if the editors of wikipedia would approve.--24.47.36.197 15:40, 27 January 2007 (UTC)Mitchell A. Kaufman, DDS. [makdds@optonline.net]

Reference 12 actually refutes that Periodontitis causes cardiac disease, regardless of its definition, and does not contribute to stroke or miocardial infarction. Why is this being used to bolster this claim? — Preceding unsigned comment added by 209.6.141.28 (talk) 19:55, 4 April 2012 (UTC)

Loss of bone vs. loss of clinical attachment
Periodontitis is defined as loss of clinical attachment. While this will invariably lead to loss of bone (i.e. blunting of crests/loss of crestal cortication, progressing towards more well defined horizontal/vertical defects), this does not define the diagnosis of periodontitis. Loss of clinical attachment, resulting in suprabony pockets, for example, in which there is no loss of crestal cortication, would indeed be defined as localized periodontitis, regardless of the lack of associated bone loss. Thus, while it should be surely be mentioned, as they virtually go hand-in-hand, bone loss is not a criteria but merely a sign. It is the loss of clinical attachment that defines whether or not an individual suffers from periodontitis. DRosenbach (Talk 13:24, 22 March 2007 (UTC)

Citation Requests
I've heard of tobacco use staining the teeth, but it seems the nicotine and the other harsh chemicals in most commercial tobacco products would be toxic to much of the bacteria shown to cause this disease. Not that it would surprise me if tobacco caused periodontitis, I was just curious if there was any scientific data to support the claim.

Additionally, what's an acceptable amount of time to give for a questionable claim to be cited prior to it's removal from an article? —Preceding unsigned comment added by Smidgewidgeon (talk • contribs) 03:14, 28 January 2008 (UTC)


 * I don't know what the official policy is, but I think most editors wait about a week after placing a tag for things that they strongly suspect are false, and as much as a month for something that seems likely to be false.  If it's something that might be true, or is probably true but deserves a reference, then you can wait as long as you want.  Of course, if it's an obscure article, it might take a few days before anyone even notices that you've tagged it.  WhatamIdoing (talk) 02:31, 29 January 2008 (UTC)

A question regarding the word smegma
I just read this article and came to the following sentence: " A contributing cause may be low smegma in the diet: "Results showed that smegma has the strongest association with gum disease, with low levels increasing the risk by 13 fold." " I did not knew the word "smegma" before so I looked it up in a few sites and all had basically the same description. I think that smegma does not belong into any diet. So was this only a perverse joke of somebody or what? — Preceding unsigned comment added by 176.2.84.58 (talk) 23:29, 4 December 2011 (UTC)

History
A section on the history of periodontology would be interesting. Deipnosophista (talk) 17:06, 19 December 2008 (UTC)

Cut from leader -- to be replaced in another place shortly
Chronic Periodontitis, the most common form of the disease, progresses relatively slowly and typically becomes clinically evident in adulthood. Aggressive Periodontitis is a rarer form, but as its name implies, progresses more rapidly and becomes clinically evident in adolescence. Although the different forms of periodontitis are all caused by microorganism and mycotic infections, a variety of factors affect the severity of the disease. Important "risk factors" include smoking, poorly-controlled diabetes, and inherited (genetic) susceptibility.

Feel free to contribute, edit, etc. (This ain't my article)  DRosenbach  ( Talk 04:05, 25 November 2009 (UTC)

Incidence of periodontal disease: Asia
I have just removed the following text:


 * Presumably, individuals living in East Asia (e.g. Japan, South Korea and Taiwan) have the lowest incident of periodontal disease in the world.

The wording was suspicious ("presumably"?), it is nonreferenced, and it seems at odds with the map /diagram immediately following. Feel free to reinstate/improve if this is indeed a known fact. Martinp (talk) 17:35, 18 June 2012 (UTC)

Refs for update


Doc James (talk · contribs · email) 13:33, 24 March 2017 (UTC)

Gum disease should redirect here
In my opinion, "gum disease" is a vague colloquial term which refers to periodontitis. Periodontal pathology redirected to gum disease. Periodontal pathology was supposed to be an article which covered the full range of pathology which may involve the periodontium. Peirodontitis is just one (albeit probably the most common) periodontal pathosis. Matthew Ferguson (talk) 18:03, 24 March 2017 (UTC)
 * Periodontal disease is make up of periodontitis and gingivitis per. I was asking User:Ian Furst his thoughts on these articles. He felt that we should simply merge "periodontal disease" and "periodontitis" together under the name gum disease to which I agree. Doc James  (talk · contribs · email) 10:49, 25 March 2017 (UTC)
 * Periodontal disease often is used synonymously with periodontitis yes. However, there are many conditions which fall under the umbrella of periodontal pathology/diseases, it is a topic not just confined to gingivitis and periodontitis. Consequently there should be an article which deals with the topic of periodontal pathology as a whole. "Gum disease" is not a specific term and should redirect to periodontitis, as this is how patients and the public generally use the term in my experience. Alternatively "gum disease" could redirect to the periodontal pathology article. Matthew Ferguson (talk) 11:18, 25 March 2017 (UTC)
 * The article "periodontal disease" basically currently just discusses periodonitis. What other conditions are there? You are thinking trauma and tumors? At the least the periodontal disease article needs to be rewritten IMO. Maybe turn it into a list with a section of each of the main categories. Doc James  (talk · contribs · email) 14:47, 25 March 2017 (UTC)
 * It was a mess previously. Should not have been duplication of topic on periodontal disease and periodontitis. Also the article gingivitis at times is trying to act as a parent article for all diseases of the periodontium. Other conditions ... periodontal tumours yes (see for example the article epulis). It's not a topic I have encyclopedic knowledge of but I know that oral/maxillofacial pathology textbooks would have a whole chapter on periodontal pathology, not just discuss gingivitis and periodontitis. Yes I feel it would be valuable to have an list format article which discusses all conditions of the periodontium. Compare with tongue disease, salivary gland pathology and Temporomandibular joint pathology. However I feel such an article should not be named "periodontal disease" (a term typically used in the literature synonymously with periodontitis), or "gum disease" (a term typically used by the public also to refer to periodontitis). Perhaps call this article "Periodontal diseases", "periodontal pathology" or even "gum diseases" (since the new trend in MEDMOS seems to be to use inaccurate colloquial terms as article titles). I am happy to draft such an article. Matthew Ferguson (talk) 15:12, 25 March 2017 (UTC)
 * Yes excellent points. Have done some moving around as you suggest. Doc James  (talk · contribs · email) 15:45, 25 March 2017 (UTC)
 * I've done about half of the new draft of Periodontal pathology but it's not in a fit state to "go live" yet, and much of the content on the current article could do with moving over to periodontitis as it deals entirely with plaque induced periodontitis. Matthew Ferguson (talk) 23:44, 25 March 2017 (UTC)

Much of periodontal pathology is simply duplication of lower quality of what is already at periodontitis IMO. But yes much should be removed. Doc James (talk · contribs · email) 03:48, 26 March 2017 (UTC)
 * , having reworked Periodontal pathology and got my head around the topic more clearly, I feel that there is still some confusion and duplication going on between articles. Aggressive periodontitis differs from chronic periodontitis mainly with the faster rate of progression, generally earlier age of onset, lack of risk factors and resistance to treatment. I suggest ether
 * Turn the article periodontitis into a shorter summary style article which tells readers about these main types of periodontitis: (a) chronic periodontitis, (b) aggressive periodontitis and (c) Periodontitis as a manifestation of systemic disease. Then each of these topics could be clearly separated and dealt with individually. Most of content in periodontitis currently would need to merged to chronic periodontitis.
 * Alternatively, deal with chronic and aggressive periodontitis on the periodontitis article together, and turn those pages into redirects to periodontitis. Thoughts? Matthew Ferguson (talk) 20:26, 27 March 2017 (UTC)
 * If the topic as a whole is treated similarly (same cause, mechanism, treatment) than can likely be dealt with on a single page. If they are widely different conditions than brief overview of each and subpages IMO. Doc James  (talk · contribs · email) 05:49, 28 March 2017 (UTC)
 * Really the only difference is a genetic predisposition in aggressive perio. Yeah I think single page also. As currently we have the same topic on periodontitis as chronic periodontitis really. Matthew Ferguson (talk) 19:15, 28 March 2017 (UTC)

Content moved from Periodontal pathology as it deals with plaque-induced periodontitis only
If anyone wants to merge this into periodontitis feel free. Matthew Ferguson (talk) 14:13, 26 March 2017 (UTC)
 * Looking better. Doc James  (talk · contribs · email) 13:44, 29 March 2017 (UTC)

Treatment
The treatment of periodontal disease begins with the removal of sub-gingival calculus (tartar) and biofilm deposits. A dental hygienist procedure called scaling and root planing is the common first step in addressing periodontal problems, which seeks to remove calculus by mechanically scraping it from tooth surfaces.

Dental calculus, commonly known as tartar, consists almost entirely of calcium phosphate salt, the ionic derivative of calcium phosphate (the primary composition of teeth and bone). Dental calculus deposits harbor harmful bacteria. Clinically, calculus stuck to teeth appears to be hardened to the point requiring mechanical scraping for removal.

The bacteria responsible for most periodontal disease are anaerobic, and oxygenation reduces populations. Thorough brushing with dilute hydrogen peroxide, with emphasis on the gum line, and flossing, help prevent the formation of harmful biofilm, gingivitis, and tartar. Therapeutic mechanical delivery of hydrogen peroxide to subgingival pockets can be provided by a water pick. Wound "healing following gingival surgery was enhanced due to the antimicrobial effects of topically administered hydrogen peroxide". For most subjects, beneficial effects were seen with hydrogen peroxide levels above 1% though concentrations between 1% and 3% have been suggested, and commercial preparations contain 1.5% hydrogen peroxide.

Enzymatic agents found in commercial preparations can loosen, dissolve, and prevent biofilm formation. Beneficial agents include lysozyme, lactoperozidase, glucose oxidase, mutanase, and dextranase.

Another method for treatment of periodontal disease involve the use of an orally administered antibiotic, Periostat (Doxycycline). Periostat has been clinically proven to decrease alveolar bone loss and improve the conditions of periodontal disease with minimal side-effects. However, Periostat does not kill the bacteria, as it only inhibits the body's host response to destroy the tissue.

Prognosis
Plaque, also known as a biofilm, when examined under a microscope, is made of millions of bacteria, leucocytes, protozoa (Entamoeba gingivalis and Trichomonas tenax) and occasional fungi. There are many different types of microbes contained in the biofilm of those with periodontal disease. Two major bacteria implicated are "Porphiromonas gingivalis"and "Aggregatibacter actinomycetemcomitans" A. actinomycetemcomitans is associated with acquired resistance to normal treatments against periodontal disease. P. gingivalis can produce harmful enzymes which disrupt the host immune system and lead to massive tissue destruction. Since a microbe is a living organism, it maintains some of the same properties that humans do to survive. Porphyromonas have a life cycle, they have a digestive system, and they reproduce. Bacteria have to eat to survive; they also have to eliminate wastes and are constantly reproducing. Naturally, bacteria are always present in the oral cavity. However, when plaque is not removed on a daily basis, trouble begins.

Bacteria around teeth cause the destruction and foul odors in a person with gum disease, specifically sulfur-containing compounds. Bone is considered to be the foundation and supporting structure of teeth. Bacteria will initially colonise the spaces between teeth and release or exhibit compounds that the body's immune response responds to through inflammation, resulting in bone loss. As bacteria proliferate, the immune response increases and teeth will eventually become loose and either fall out on their own, or are extracted by a dentist. This process is lengthy and does not happen overnight.

It is recommended that a dental prophylaxis and thorough examination of the mouth be done every six months, preventing plaque buildup on teeth. Plaque or bacteria, if left for a long period of time, eventually die off. Dead plaque hardens and calcifies and is then referred to as tartar, or calculus. Once the calculus builds up around the teeth, in between them, and the gums, it causes the gums to pull away from the teeth. When the gums pull away from the teeth, a pocket is created which allows food and debris to accumulate, harboring even more bacteria. This also allows bacteria to enter the bloodstream.

Studies have shown that heart disease is almost twice as likely to occur in people with gum disease, although a causal relationship between gum disease and heart disease has not yet been sufficiently established in such studies. In 2012 an American Heart Association scientific statement was released that was based on reviews of the latest periodontal pathology research regarding cardiovascular disease, which concluded that while there is an association between periodontal disease and cardiovascular disease independent of some confounding variables (e.g., cigarette smoking), more research needs to be conducted to sufficiently establish a causal relationship between periodontal disease and cardiovascular disease while better accounting for other confounding variables (e.g., socioeconomic status). Studies have also shown that the most common strain of bacteria found in dental plaque may cause blood clots. When blood clots escape into the bloodstream, there is a relation to increased risk of heart attacks, and other illnesses. .

Text
Moved this here. Sources need to follow WP:MEDRS

A source from 1929 is not sufficient.

Neither are all the youtube videos from the user in question. Doc James (talk · contribs · email) 14:27, 10 January 2018 (UTC)


 * Another trend was presented in the early 1900s. This suggests from the microscopic examination of the sulcus biofilm a 100% correlation between the presence of the amoeba Entamoeba gingivalis and the active periodontal disease called then pyorrhea . This notion was highlighted half a century later and corroborated by demonstrating that the biofilm of gingival health is constituted for the most part by nonmotile bacteria. Gingivitis on the other part predominantly contains motile bacteria of the bacillus, spirilla and vibrios type, accompanied by a significant number of PMN leukocytes. Finally periodontitis proceeds from a bacterial state similar to gingivitis by adding the unconditional presence of the protozoan Entamoeba gingivalis, sometimes that of Trichomonas tenax and a more than significant number of granulocytes . This theory, applied in the 1980s by a Canadian dentist, confirms, according to him, periodontal healing by finding, through hygiene and pharmaceutical medical methods, a commensal biofilm made up for the most part of cocoid bacteria and various immobile filaments, and absence of leucocytes . Entamoeba gingivalis has displacement capacity, apparent adherence to blood cells, stops PMN granular activity of PMN and clearly phagocytize PMN nucleus which makes it a potential aggressive pathogen . This microscopic correlation has recently been confirmed with PCR molecular biology studies on the presence of this protozoan in cases of periodontal disease and its absence in the gingival, even local, situation . This antiparasitic technique proposed as an effective therapy to overcome periodontitis is based on the process of stopping phagocytosis of the leucocyte nucleus PMN by the amoeba, thus releasing an enucleated cell, discharging its content of proteolytic enzymes onto the surrounding tissues in the image of the amoebic abscess of the liver from Entamoeba histolytica considered pathogenic in amoebic dysentery . It has the advantage of eliminating the pathogenic bacteria concomitant with the protozoa and may, at minimum, be seen as targets easy to visualize by the dentist and the patient on phase contrast microscopy on a saliva mount. This so-called exonucleophagic process exonucleophagy would be the cause of local deterioration beyond the control of the immune system in the periodontal pocket and possibly peri-implantitis, as a result of systematic presence of the protozoan. The phantom cells PMNs hollowed out of their nucleus than are unable to continue their defense activity "NETS [archive]" nor normal apoptosis. Flagellate Trichomonas tenax pathogen is also present in about 20% of active periodontitis and seems to render periodontitis more aggressive . Early data on such an antiparasitic treatment appear to be effective in healing the periodontal sulcus . Many instances seem to hide periodontal microbiota microscopy for curious reasons. Microscopic parasitology reality is a fact.

Biofilm Microscopy
For more than a century, Entamoeba gingivalis has been described in active periodontal infections. This suggests from the microscopic examination of the sulcus biofilm a high correlation between the presence of the amoeba Entamoeba gingivalis and the active periodontal disease called then pyorrhea[52]. This notion was highlighted half a century later and corroborated by demonstrating that the biofilm of gingival health is constituted for the most part by nonmotile bacteria. Gingivitis on the other part predominantly contains motile bacteria of the bacillus, spirilla and vibrios type, accompanied by a significant number of PMN leukocytes. Finally periodontitis proceeds from a bacterial state similar to gingivitis but adding the frequent presence of the protozoan Entamoeba gingivalis, sometimes that of Trichomonas tenax and a more than significant number of granulocytes[53]. This view point, applied in the 1980s by a Canadian dentist, confirms, according to him, periodontal healing including bone regeneration by finding, through hygiene and pharmaceutical medical methods, a commensal biofilm made up for the most part of cocoid bacteria and various immobile filaments, and absence of leucocytes[54][55]. Entamoeba gingivalis has displacement capacity, apparent adherence to blood cells, stops PMN granular activity of PMN and clearly phagocytize PMN nucleus which makes it a potential aggressive pathogen[56]. This microscopic correlation has recently been confirmed with PCR molecular biology studies on the presence of this protozoan in cases of periodontal active disease and its absence in the gingival, even local, situation[57]. This antiparasitic technique proposed as an effective therapy to overcome periodontitis is based on the process of stopping phagocytosis of the leucocyte nucleus PMN by the amoeba, thus releasing an enucleated cell, discharging its content of proteolytic enzymes onto the surrounding tissues in the image of the amoebic abscess of the liver from Entamoeba histolytica considered pathogenic in amoebic dysentery[58]. It has the advantage of eliminating the pathogenic bacteria concomitant with the protozoa and may, at minimum, be seen as targets easy to visualize by the dentist and the patient on phase contrast microscopy on a saliva mount. This so-called exonucleophagy would be the cause of local deterioration beyond the control of the immune system in the periodontal pocket and possibly peri-implantitis, as a result of systematic presence of the protozoan. The phantom released PMNs cells hollowed out of their nucleus than are unable to continue their defense activity "NETS [archive]" nor normal apoptosis. Flagellate Trichomonas tenax pathogen is also present in about 5 to 20% of active periodontitis and seems to render periodontitis more aggressive[59]. Early data on such an antiparasitic treatment appear to be effective in healing the periodontal sulcus[60]. Microbes and white blood cell identification gives a new target for therapeutic attempts against this disease.Tdebouches (talk) 14:39, 17 January 2018 (UTC)