Eventual Tooth Loss Research Articles

Scaffolds in periodontal regeneration- A brief review

The periodontium constitutes the supportive framework of a tooth, comprising the integration of the periodontal ligament, cementum, gingiva, and alveolar bone. The periodontium's health is compromised by the infiltration of bacteria due to local or systemic factors. Untreated periodontal disease can lead to the loss of attachment and eventual tooth loss, necessitating effective therapy. Tissue engineering is a multidisciplinary approach that combines engineering techniques with life sciences principles to generate biological substitutes for damaged tissues, aiming to restore, maintain, or enhance their function. In recent years, various scaffolding technologies have emerged, transitioning from monophasic to multi-phasic/bioactive scaffold systems, with the goal of three-dimensional regeneration of periodontal tissue rather than mere promotion of healing. This review discusses tissue engineering principles, materials, and recent advancements in scaffold design for periodontal tissue regeneration, along with their efficacy tested both in vitro and in vivo.

Clinical Features, Etiopathogenesis, and Therapeutic Approaches of Acute Gingival Lesions: A Narrative Review.

A bacterial infection is typically the source of gingivitis, a non-destructive condition that produces gum inflammation. Unlike chronic lesions, which have well-defined features and a gradual onset, acute lesions are unpleasant. Usually, the first symptoms are bleeding, swollen, and red gums. If gingivitis is not treated, it can lead to periodontitis, a more serious condition where the gums separate from the teeth. It seems that gingival disease-induced inflammation is a necessary condition for the breakdown of connective tissue attachment apical to the cementoenamel junction (CEJ). This may result in damage to the bone and soft tissue that support the teeth, leading to loosening and unstable teeth, andif the infection worsens, eventual tooth loss may occur. While one of the most prevalent inflammatory diseases in humans is plaque-induced gingivitis, there are several less common but frequently very significant non-plaque-induced gingival illnesses. Maintaining regular dental hygiene can help prevent gingivitis and make it reversible. Non-plaque-induced gingival lesions might be pathologic alterations restricted to gingival tissues, but they are also frequent signs of systemic disorders. Diagnosing patients with these lesions and creating treatment regimens for them must be the aim of the therapy.

Choline and geranate ionic liquid for subgingival biofilm control

Periodontitis is a chronic inflammatory disease that causes destruction of the periodontium and eventual tooth loss. The priority in the periodontal treatment is to remove the subgingival biofilm. Chemical removal of biofilms using antimicrobial agents has been applied in clinical practice. However, their clinical effect is still limited because the agents must overcome biofilm’s significant drug tolerance, which is primarily caused by the extracellular matrix, a physical barrier that attenuates drug diffusion. This study aimed to study the use of ionic liquids (ILs), a new class of biocompatible materials, for controlling subgingival biofilms because of their excellent permeability. Choline and geranate (CAGE) IL was tested for its highly potent antiseptic behavior and permeability. Antibacterial tests revealed that the significant efficacy of CAGE against periodontopathic microorganisms was derived from their ability to destroy cell membrane, as demonstrated by membrane permeability assay and transmission electron microscopy imaging. Antibiofilm tests using two pathogenic biofilm models revealed that CAGE exerted efficacy against the biofilm-embedded bacteria, conspicuously neutralized the biofilms, and eventually destroyed the biofilm structure. Furthermore, the penetration of CAGE into the biofilm was visually confirmed using confocal laser scanning microscopy. This study highlighted the potential of CAGE as a powerful antibiofilm therapeutic.

Auxiliary Diagnosis of Dental Calculus Based on Deep Learning and Image Enhancement by Bitewing Radiographs.

In the field of dentistry, the presence of dental calculus is a commonly encountered issue. If not addressed promptly, it has the potential to lead to gum inflammation and eventual tooth loss. Bitewing (BW) images play a crucial role by providing a comprehensive visual representation of the tooth structure, allowing dentists to examine hard-to-reach areas with precision during clinical assessments. This visual aid significantly aids in the early detection of calculus, facilitating timely interventions and improving overall outcomes for patients. This study introduces a system designed for the detection of dental calculus in BW images, leveraging the power of YOLOv8 to identify individual teeth accurately. This system boasts an impressive precision rate of 97.48%, a recall (sensitivity) of 96.81%, and a specificity rate of 98.25%. Furthermore, this study introduces a novel approach to enhancing interdental edges through an advanced image-enhancement algorithm. This algorithm combines the use of a median filter and bilateral filter to refine the accuracy of convolutional neural networks in classifying dental calculus. Before image enhancement, the accuracy achieved using GoogLeNet stands at 75.00%, which significantly improves to 96.11% post-enhancement. These results hold the potential for streamlining dental consultations, enhancing the overall efficiency of dental services.

Aggressive Periodontitis: A case report with exome sequencing and functional characterization of identified variant

Aggressive periodontitis (AgP) is characterized by rapid and progressive destruction of the periodontal tissues and eventual tooth loss. Genetic risk contributions have been explored and rare mutations in NOD2 were reported. Sequencing analysis of the coding regions of NOD2 was conducted using individuals of African ancestry, to identify the pathogenic protein-altering variants in individuals with AgP using: 1) In Silico tools and clinical variant classification system; 2) IF staining to understand the expression pattern, and 3) In vitro cell based assay to understand the variant protein function. We discovered a novel nonsense NOD2 variant (c.835G>T; p.Glu279Ter) ; a truncating protein variant that is clinically pathogenic, and the gene-product lacks domains regulating inflammatory responses. Murine studies suggest that this gene contributes to tooth development. In vitro analysis suggests a dominant-negative effect of the variant. NOD2 gene is expressed in the immune cells and periodontal tissues and regulates the inflammatory response within this tissue. This truncating variant found in one African family, which results in a dominant-negative effect, could explain the exacerbated immune response to pathogens in the pathogenesis of this periodontal disease.

Specific delivery of metronidazole using microparticles and thermosensitive in situ hydrogel for intrapocket administration as an alternative in periodontitis treatment

Periodontitis is a common chronic inflammatory disease primarily caused by the prevalence of bacterial overgrowth resulting in the development of an inflammatory condition that destroys the tooth’s supporting tissues and eventual tooth loss. Comparatively, to other treatment methods, it is difficult for topical antibacterial drugs to effectively permeate the biofilm’s physical barrier, making conventional therapy for periodontitis more challenging. This novel study combines thermosensitive in situ hydrogel with microparticles (MPs) to enhance the targeted delivery of metronidazole (MET) to the periodontal pocket. Polycaprolactone (PCL) polymer was utilized to produce bacteria-sensitive MPs. Additionally, the study assessed the attributes of MPs and demonstrated an enhancement in the in vitro antibacterial efficacy of MPs towards Staphylococcus aureus (SA) and Escherichia coli (EC). Subsequently, we incorporated MET-MPs into thermosensitive in situ hydrogel formulations using chitosan. The optimized formulations exhibited stability, appropriate gelation temperature, mucoadhesive strength, and viscosity. In vitro permeation tests showed selective and prolonged drug release against SA and EC. Ex vivo experiments demonstrated no significant differences between in situ hydrogel containing pure MET and MET–MPs in biofilm quantity, bacterial counts, and metabolic activity in biofilms. According to in vitro tests and the effectiveness of the antibacterial activity, this study has exhibited a novel methodology for more efficacious therapies for periodontitis. This study aims to utilize MET in MPs to improve its effectiveness, enhance its antibacterial activity, and improve patient treatment outcomes. In further research, the efficacy of the treatment should be investigated in vivo using an appropriate animal model.

Polylysine-derived carbon quantum dots modulate T lymphocyte responses for periodontitis treatment

Periodontitis, a common chronic inflammatory disease, is characterized by T cell responses leading to gradual alveolar bone loss and eventual tooth mobility or loss. Herein, polylysine-derived carbon quantum dots (PLL-CQDs) are synthesized via the pyrolysis method to facilitate the recovery of periodontal bone loss induced by periodontitis by modulating T cell phenotype. The PLL-CQDs, characterized by small particle size (2.31 ± 0.70 nm) and fluorescence properties, preserved the positive charge of PLL, affirming successful preparation. In vitro studies revealed that PLL-CQDs significantly increased T cell proliferation in a concentration-dependent manner, while effectively suppressing differentiation into CD4+ phenotype. Furthermore, they promoted alkaline phosphatase expression and calcium nodule formation in MC3T3-E1 cells, indicating potential for periodontal bone regeneration. In vivo experiments demonstrated that PLL-CQDs mitigated alveolar bone resorption and modulated periodontal tissue inflammation. Overall, PLL-CQDs exhibited the ability to regulate T cell differentiation and expedite periodontal bone healing, offering promising implications for periodontitis treatment and suggesting novel strategies for addressing immune-associated bone diseases using CQDs.

Serum levels of antimicrobial peptides (Cathelicidins and Beta Defensins-1) in patients with periodontitis

Background: periodontitis is a multifactorial oral inflammatory disease characterized by the gradual loss of bone and eventual tooth loss. It starts with microbes and is then influenced by the environment. A diverse family of host defense major compounds known as antimicrobial peptides react quickly to combat microbial invasion and challenge. These little cationic peptides are crucial for the development of innate immunity. The goal of this study was to evaluate the blood levels of healthy individuals and patients with periodontitis for cathelicidins and human beta-defensin-1. In this case-control study, 35 healthy volunteers (matched exactly by age and sex to the patients) and 50 periodontitis patients (aged 20 to 59) participated. In this investigation, periodontal parameters such as plaque index, gingival index bleeding on probing, probing pocket depth, and clinical attachment loss were employed. The levels of cathelicidins and human beta-defensin-1 in patients and controls were estimated using ELISA after blood samples from all individuals were taken. The current findings showed that the mean levels of cathelicidin and human beta defensin-1 were significantly higher (P˂0.01) in the patient group compared to the control group, and that there was no significant correlation with all clinical periodontal parameters. These findings support the notion that antimicrobial peptides play a crucial role in periodontitis' inflammatory process.

Technological advancements for the management of oral biofilm

The oral cavity provides an excellent opportunity for the formation of biofilm on its various surfaces due to the presence of sumptuous nutrients and other favourable environments. Biofilm formed on the dental surface leads to caries, which ultimately leads to diseases like periodontitis and eventual tooth loss. Biofilm formation on the dental surface causes caries, which eventually leads to diseases like periodontitis and tooth loss. A high volume of research is being conducted to manage the oral biofilm, which may cause not only dental problems but also a variety of systemic disorders. Nanotechnology, as part of modern technological advancement, is used in a variety of ways to manage oral biofilm. Nanoparticles, nanocomposites, and other nano configurations have been found to be effective in eradicating oral biofilm and are a promising candidate for the preparation of tooth pastes and mouthwash. The nanorobots, in the form of dentifrobots and surface topography-adaptive robotic superstructures (STARS), can reach each and every corner of the oral cavity to convey the drug using the ferromagnetic component as a propulsion force.Proper detection of dental biofilm may be precisely done with the help of artificial intelligence by a computer-assisted detection system based on a deep convolutional neural network (CNN) algorithm. Hence, the recent hi-tech achievement can easily replace the tedious conventional techniques of oral biofilm management and add convenience to dental and oral therapeutics.

Dental niche cells directly contribute to tooth reconstitution and morphogenesis.

Mammalian teeth develop from the inductive epithelial-mesenchymal interaction, an important mechanism shared by many organs. The cellular basis for such interaction remains elusive. Here, we generate a dual-fluorescence model to track and analyze dental cells from embryonic to postnatal stages, in which Pitx2+ epithelium and Msx1+ mesenchyme are sufficient for tooth reconstitution. Single-cell RNA sequencing and spatial mapping further revealed critical cellular dynamics during molar development, where tooth germs are organized by Msx1+Sdc1+ dental papilla and surrounding dental niche. Surprisingly, niche cells are more efficient in tooth reconstitution and can directly regenerate papilla cells through interaction with dental epithelium. Finally, from the dental niche, we identify a group of previously unappreciated migratory Msx1+ Sox9+ cells as the potential cell origin for dental papilla. Our results indicate that the dental niche cells directly contribute to tooth organogenesis and provide critical insights into the essential cell composition for tooth engineering.

Periodontal Therapy Using Bioactive Glasses: A Review

This paper reviews the use of bioactive glasses as materials for periodontal repair. Periodontal disease causes bone loss, resulting in tooth loosening and eventual tooth loss. However, it can be reversed using bioactive glass, typically the original 45S5 formulation (Bioglass®) at the defect site. This is done either by plcing bioactive glass granules or a bioactive glass putty at the defect. This stimulates bone repair and causes the defect to disappear. Another use of bioactive glass in periodontics is to repair so-called furcation defects, i.e., bone loss due to infection at the intersection of the roots in multi-rooted teeth. This treatment also gives good clinical outcomes. Finally, bioactive glass has been used to improve outcomes with metallic implants. This involves either placing bioactive glass granules into the defect prior to inserting the metal implant, or coating the implant with bioactive glass to improve the likelihood of osseointegration. This needs the glass to be formulated so that it does not crack or debond from the metal. This approach has been very successful, and bioactive glass coatings perform better than those made from hydroxyapatite.

Periodontitis as a Risk Factor for Alzheimer's Disease: The Experimental Journey So Far, with Hope of Therapy.

Periodontitis and Alzheimer's disease (AD) exist globally within the adult population. Given that the risk of AD incidence doubles within 10years from the time of periodontal disease diagnosis, there is a window of opportunity for slowing down or preventing AD by risk-reduction-based intervention. Literature appraisal on the shared risk factors of these diseases suggests a shift to a healthy lifestyle would be beneficial. Generalised (chronic) periodontitis with an established dysbiotic polymicrobial aetiology affects the tooth supporting tissues with eventual tooth loss. The cause of AD remains unknown, however two neurohistopathological lesions - amyloid-beta plaques and neurofibrillary tangles, together with the clinical history, provide AD diagnosis at autopsy. Historically, prominence was given to the two hallmark lesions but now emphasis is placed on cerebral inflammation and what triggers it. Low socioeconomic status promotes poor lifestyles that compromise oral and personal hygiene along with reliance on poor dietary intake. Taken together with advancing age and a declining immune protection, these risk factors may negatively impact on periodontitis and AD. These factors also provide a tangible solution to controlling pathogenic bacteria indigenous to the oral and gastrointestinal tract microbioes in vulnerable subjects. The focus here is on Porphyromonas gingivalis, one of several important bacterial pathogens associated with both periodontitis and AD. Recent research has enabled advances in our knowledge of the armoury of P. gingivalis via reproduction of all clinical and neuropathological hallmark lesions of AD and chronic periodontal disease in vitro and in vivo experimental models, thus paving the way for better future management.

Prevalence Of Epstain–Bar Virus Among Patients With Periodontitis In Al–Najaf Al–Ashraf / Iraq

Periodontitis, a complex chronic inflammatory disease caused by subgingival infection, is among the most prevalent microbial diseases in humans which characterized by periodontal damage, alveolar bone resorption, pain, and eventual tooth loss. Epstein–Barr Virus (EBV) has widely infected >90% adults in the world and is associated with many human diseases, so that this study aimed to investigate the association between EBV and periodontitis.
 Patients and samples: Subgingival paper point samples were collected from 100 patients with periodontitis and 30 healthy people. All samples undergo direct DNA extraction to amplified EBVs DNA using PCR technique.
 The results indicated a high percentage of EBV infections (18%) in patient suffering from periodontitis while there was no EBV infection were detected in healthy persons. A high percentage of EBV was detected in female (56%) in comparison with male (44%).
 The results improved the association between EBV and periodontitis suggesting that EBV may serve as a pathogenic factor leading to periodontitis among patients.

Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BackgroundDental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth.MethodThis is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes.DiscussionSCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making.Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

MiR-23b mediates TNF-α-Inhibited Osteogenic Differentiation of Human Periodontal Ligament Stem Cells by Targeting Runx2.

Periodontitis is the most prevalent oral infection disease, which causes the destruction of periodontal supporting tissues and eventual tooth loss. This study aimed to investigate the molecular mechanism of miRNA-23b (miR-23b) in regulating the osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) in an inflammatory environment. Results revealed that tumor necrosis factor-α (TNF‐α), a notoriously inflammatory cytokine, remarkably attenuated the osteogenic differentiation of hPDLSCs, which were partially rescued by SKL2001 (Wnt/β-catenin agonist). We further explored the underlying roles of miRNAs involved in TNF-α-inhibited osteogenesis of hPDLSCs. The miR-23b significantly increased with TNF-α stimulation, which was abolished by SKL2001. Similar to the effect of TNF-α, miR-23b agonist (agomir-23b) dramatically reduced the expression of runt-related transcription factor 2 (Runx2) and suppressed the osteogenic differentiation of hPDLSCs. The inhibition of miR-23b significantly increased Runx2, which is the major transcription factor during osteogenesis, thereby indicating that miR-23b was an endogenous regulator of Runx2 in hPDLSCs. Bioinformatic analysis and dual luciferase reporter assays confirmed that Runx2 was a target gene of miR-23b. Furthermore, the gain function assay of Runx2 revealed that the Runx2 overexpression efficiently reversed the suppression of the osteogenic differentiation of hPDLSCs with miR-23b agonist, suggesting that the suppressing effect of miR-23b on osteogenesis was mediated by Runx2 inhibition. Our study clarified that miR-23b mediated the TNF-α-inhibited osteogenic differentiation of hPDLSCs by targeting Runx2. Therefore, the expanded function of miR-23b in the osteogenesis of hPDLSCs under inflammatory conditions. This study might provide new insights and a novel therapeutic target for periodontitis.

Geomorphologic study of human tooth root surfaces following simulated avulsion by scanning electron microscopy.

Tooth avulsion is the most severe traumatic tooth injury. Immediate replantation after avulsion provides the highest success rate, whereas delayed replantation with dehydration for >1h always results in ankylosis, replacement resorption, and eventual tooth loss. The aim of this study was to investigate the geomorphologic change of ultrastructure on tooth root surfaces due to dehydration. Twenty-four sound human premolars and fully developed third molars without periodontitis were selected for the experiment. Roots were separated into 6-7 pieces with an intact root surface area (3×3mm2 ) and then divided into the following groups: fresh group, prolonged dehydration groups (air drying for 1, 2, 4, 12, or 24h), and dehydrated teeth (air drying for 2h) treated with acid (Tris-HCl buffer or citric acid buffer). More than six pieces of root from each group were subjected to scanning electron microscopy (SEM) observation. Captured images were exported to ImageJ software to quantitatively analyze the areas covered with fibers. Statistical significance was determined by comparing the means of the different groups using t-testing or one-way analysis of variance followed by post hoc testing. Fibrous "vegetation" covering the cementum was observed on the fresh root surface by SEM. This was destroyed by dehydration (>1h), resulting in a root surface resembling the "Gobi Desert." The difference was statistically significant (p<.001). Root surface deteriorated by dehydration could be recovered by the re-use of the fibers embedded in the cementum as acid demineralization of the outer layer of cementum exposed the embedded fibers to simulate the geomorphology of fresh root surface. Dehydrated teeth had deteriorated geomorphology of the root surface, which could be reversed by the re-use of the fibers embedded in the cementum using citric acid. Direct evidence from SEM gives new insights into the replantation of dehydrated avulsed teeth.

Study of the Antibacterial Activity of a New Prolonged-Release Dental Dosage form Containing Doxycycline and Lidocaine

A dental infection, Gingivitis is a common and mild form of gum disease (periodontal disease) that causes irritation, redness and swelling (inflammation) of your gums. Gingivitis is able to escort to much more grave gum disease (periodontitis) and eventual tooth loss. To treat dental problems painkillers along with antibiotics and some dental paints are the commonly prescribed But the common side effects of most of the painkillers are hyperacidity and gastric irritation most antibiotics due to slow onset of action and hepatic “first-pass” effect fail to produce prompt and prolong actions. Moreover, most of the dental formulations are washed out by saliva within a few hours of application. Hypothesis of the study is that if a soft moldable gummy material containing analgesic as well as antibiotic drugs is attached to an offending tooth and sustained drug release occurs from it, a extended local action of the drugs is achieved. Ethyl cellulose, gum tragacanth, hydroxyl propyl cellulose, PEG-400 and carbopol 934 were used to prepare denticap containing Doxycycline hydrate and lidocaine.

Proteomic analysis of whole saliva in chronic periodontitis

Periodontitis is a chronic inflammatory disease resulting from a dysbiosis of the dental biofilm and a dysregulated host response in susceptible individuals. It is characterized by periodontal attachment destruction, bone resorption and eventual tooth loss. Salivary biomarkers have been sought to predict and prevent periodontitis. This comparative study analyzed the salivary proteome of individuals with chronic periodontitis (CP) and periodontal health (PH) and correlated specific proteins with clinical parameters of disease by using mass spectrometry. Stimulated whole saliva was obtained 10 PH and 30 CP patients and pooled into 5 healthy control samples and 15 CP samples. After precipitation with TCA, samples were digested enzymatically with trypsin and analyzed by a LTQ Orbitrap Velos equipped with a nanoelectrospray ion source. A wide range of salivary proteins of various functions was significantly reduced in CP individuals, whereas salivary acidic proline-rich phosphoprotein, submaxillary gland androgen-regulated protein, histatin-1, fatty acid binding protein, thioredoxin and cystatin-SA were predominant in diseased patients and correlated significantly with signs of periodontal attachment loss and inflammation. In conclusion, few specific salivary proteins were associated with CP. These findings may contribute to the identification of disease indicators or signatures for the improvement of periodontal diagnosis. SignificancePeriodontitis is a chronic inflammatory disease that results in periodontal attachment destruction, bone resorption and eventual tooth loss. Salivary biomarkers have been sought to predict periodontitis. The analysis of the salivary proteome of individuals with chronic periodontitis indicated that several proteins of various functions were significantly reduced in these individuals, except for salivary acidic proline-rich phosphoprotein, submaxillary gland androgen-regulated protein, histatin, fatty acid binding protein, thioredoxin and cystatin. Differences in salivary proteome profiles between periodontal health and periodontitis may contribute to the identification of disease indicators and to the improvement of periodontal diagnosis and treatment.

The burden of periodontal disease

Periodontal disease is the most common chronic inflammatory disease seen in humans. It is a major public health concern, and in its severe form affects approximately 10.8% or 743 million people aged 15−99 worldwide. Trends such as the rise of smoking in developing countries, the obesity and diabetes epidemic, coupled with an ageing population with greater tooth retention, are all likely to increase the burden of periodontitis still further in the UK and worldwide. Consequences of periodontitis include hypermobility of teeth, tooth migration, drifting and eventual tooth loss. Tooth loss can directly affect the quality of life of a person in terms of reduced functional capacity, self-esteem and social relationships. CPD/Clinical Relevance: This article reports the prevalence of periodontal disease in the UK and worldwide, along with the consequences of periodontitis. The importance of timely diagnosis to avoid litigation is discussed, as is the importance of effective management of periodontitis in order to improve patients' oral health-related quality of life.

The role of maintenance in periodontal disease

There is increasing recognition, made explicit in the new classification for periodontitis, that periodontitis is a lifelong disease that is not ‘cured’ but rather ‘managed’. This paper focuses on how the response to periodontal treatment is ideally measured and how decisions are made as to whether the treatment has been ‘successful’ or not. The roles of both the patient and practitioner in the maintenance of periodontal health for those patients who respond to initial therapy are crucial. Patients not responding to initial, non-surgical periodontal therapy also need to be appropriately managed, as outlined in this paper. CPD/Clinical Relevance: This paper highlights the importance of maintenance of periodontal health, as an integral part of the overall management of patients with periodontitis, in order to minimize further periodontal breakdown and eventual tooth loss.