Periodontal diagnosis: evaluation of current concepts and future needs

Periodontal diseases are multifactorial pathologies that manifest clinically by destruction of the soft and hard tissues. Bacterial insult has been implicated in the initiation of these diseases, however the degree of destruction is dependent on the host response. The host response varies from individual to individual depending on many factors including the type of the bacterial insult, the duration of the insult, the local and environmental contributing factors, immunological and inflammatory responses, predisposing genetic factors, and association with systemic diseases. The classical methods of periodontal diagnosis have been limited to clinical examination and radiographic evaluation. These methods essentially determine previous destruction, or history of disease. Evaluation of disease activity has been limited to longitudinal evaluation of these parameters, with limited accuracy, and predictors of future disease activity have not been available. The goal of new diagnostic methods is the early diagnosis of disease, before significant destruction has occurred, and measures of successful treatment or disease arrest. To this end, work has begun on genetic predictors of susceptibility which might be used to implement prevention programmes or alter treatment decisions.