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Periodontitis is a multifactorial disease for which several risk and susceptibility factors are proposed in the natural history of periodontitis. A risk factor for periodontitis is a factor (environmental, behavioral or biologic) confirmed by temporal sequence usually in longitudinal studies. Presence of it directly increases the probability of disease occurring and the absence of a risk factor reduces this possibility. In a classical longitudinal study of natural history of periodontitis, Loe et al found that among individuals with poor oral hygiene and no access to dental care, some develop disease at rapid rate whereas others experienced little or no disease. This variation was attributable to either unrecognized components of the environment or differences among individuals in their susceptibility to disease. Because host susceptibility may be described in terms of genetic variation, a relatively recent focus in periodontology has been to quantify the genetic risk and identify specific gene variants that determine disease susceptibility.
A proper and true diagnosis is essential in order to have rational treatment and preventive strategy also to identify sites at high risks in periodontitis patients. Our present understanding of the host-bacterial interaction emphasizes multiple complex mechanisms involved in periodontal tissue breakdown. Traditional clinical criteria are inadequate in determining sites with active tissue destruction, monitoring the response of therapy as well as to measure susceptibility to future periodontal breakdown. Recent immunochemical, molecular and genetic based approach has offered a new avenue in periodontal diagnosis research. This book illustrates various diagnostic methods used to detect, monitor as well as measure the sites with active periodontal disease.
Cigarette smoking represents a major preventable cause of human disease. Smokers have significantly elevated risks of all-cause mortality and developing a variety of pathological conditions. A direct causal relationship between smoking exposure and the prevalence and the severity of periodontal disease has been firmly established. Based on this evidence, dental health professionals should advise patients about tobaccös negative health effects as well as the benefits of quitting tobacco use. Tobacco cessation counseling should be a part of the armamentarium of the dental office.
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