Plaque-related diseases are a variety of entities where bacterial accumulations (biofilm) on teeth or oral implants trigger a chronic inflammatory subject host-response leading to different pathological conditions. These complex bacterial–host interactions are modulated by both genetic and behavioral factors responsible for the heterogeneity of the expression of these diseases, ranging from localized inflammation of the gingival margin (gingivitis) to wide-spread generalized destruction of the periodontal and peri-implant (periodontitis or peri-implantitis) tissues. These diseases, different to other chronic infectious conditions are not related to a single bacterial pathogen, but to a mixed infection composed of many true pathogens and opportunistic commensals residing in the oral cavity. Primary or secondary prevention against these diseases requires regular oral hygiene procedures to control the daily accumulation of dental plaque, together with professional removal of these bacterial accumulations and retentive factors at regular intervals.
The prevalence of periodontal diseases is fairly high among adults, and approximately 5–15 % develop severe disease. When the disease is diagnosed early and the periodontal destruction has not occurred (gingivitis) or is moderate (early and moderate periodontitis), its non-surgical therapy successfully eliminates the infection causing the chronic inflammation and tissue destruction. The general dentist in collaboration with the rest of the dental team, mostly dental hygienists, usually renders this therapeutic intervention. However, when the disease is diagnosed in the most advanced stages (severe periodontitis), its therapy often needs more elaborate curative treatments such as periodontal surgery in order to further eliminate the infection and to create an environment, which can be maintained free of significant inflammation by the patient. These differences in treatment levels, preventive versus curative, with the eventual need for advanced surgical treatment have important consequences on the workforce and costs of therapy. In any case these diseases can be treated successfully and the natural dentition can be preserved. |
