Diagnosing periodontal disease: new tools to solve an old problem

A review is presented of newly developed approaches to the treatment of periodontal disease (disease of the gums and other structures that support the teeth). If untreated, periodontitis (inflammation of the gums and other structures around the teeth) can lead to loss of bone, teeth, and jaw mobility, as well as to the formation of abscesses. Older methods of evaluating periodontal health include probing and radiography, but these provide only limited information about the ongoing nature of disease. Radiographs (X-rays), for instance, cannot tell when visible damage occurred, and probing only reveals damage when it has progressed considerably. Newer methods allow testing for bacteria in the mouth that are believed to cause periodontal disease. Formerly, bacteria had to be grown under laboratory conditions to allow their identification, a process impossible for many mouth bacteria, which die on exposure to air. Now, DNA probe technology can compare the DNA of sampled bacteria with known patterns, regardless of whether the bacteria are dead or alive. Progress has also been made in knowledge regarding the bacterial strains that cause periodontal disease: at least 15 such strains are believed to be pathogens in adults. Immunological tests to evaluate host (patient) response to pathogens are under development, as are tests that evaluate the activity of periodontal disease. Some of these simply involve the insertion of strips into the area near the tooth to test for concentrations of enzymes associated with tissue damage or destruction. Bone scans can help gauge the extent of bone disease, and radiographic techniques have been improved so that very small changes can be detected. Electronic probes can reduce the errors and variability inherent in manual probing. (Consumer Summary produced by Reliance Medical Information, Inc.)