The role of the microbiota in periodontal disease

The last decade has witnessed unparalleled advances in our understanding of the complexity of the oral microbiome and the compositional changes that occur in subgingival biofilms in the transition from health to gingivitis and to destructive periodontal disease. The traditional view, which has held sway for the last 2 decades, that disease is characterized by the outgrowth of a consortium, or consortia, of a limited number of potentially pathogenic organisms, has given way to an alternative paradigm. In this new view, the microbiological changes associated with disease represent whole-scale alterations to the overall microbial population structure and to the functional properties of the entire community. Thus, and in common with other microbially mediated diseases of the gastrointestinal tract, the normally balanced, symbiotic, and generally benign commensal microbiome of the tooth-associated biofilm undergoes dysbiosis to a potentially deleterious microbiota. Coincident with progress in defining the microbiology of these diseases, there have been equally important advances in our understanding of the inflammatory systems of the periodontal tissues, their control, and how inflammation may contribute both to the development of dysbiosis and, in a deregulated state, the destructive disease process. One can therefore speculate that the inflammatory response and the periodontal microbiome are in a bidirectional balance in oral health and a bidirectional imbalance in periodontitis. However, despite these clear insights into both sides of the host/microbe balance in periodontal disease, there remain several unresolved issues concerning the role of the microbiota in disease. These include, but are not limited to, the factors which determine progression from gingivitis to periodontitis in a proportion of the population, whether dysbiosis causes disease or results from disease, and the molecular details of the microbial stimulus responsible for driving the destructive inflammatory response. Further progress in resolving these issues may provide significant benefit to diagnosis, treatment, and prevention.     

The role of the prosthodontist regarding aspirative dysphagia.

Certain swallowing disorders characteristically may follow head and neck surgeries and neurologic disorders. Aspiration is one of the possible symptoms of dysphagia. Since aspiration can be life-threatening, prosthodontists should help to identify patients who aspirate. This article describes the normal swallowing physiology, the pathophysiology of swallowing disorders, and the prosthetic role in the treatment of patients experiencing head and neck surgical operations and neurologic disorders that may cause aspiration.     

The role of occlusion in periodontal disease

Observations made from animal experiments have implicated jiggling forces' in the aetiology of some infra-bony defects. However, this article develops the hypothesis that advanced, localized bone defects may develop when teeth are overloaded and that these changes occur in patients who suffer from only a mild gingival inflammation.     

The continuing role of the prosthodontist in the treatment of patients with cleft lip and palate.

The prosthodontist can fill a unique position on the cleft-palate team by aggressive participation in every phase of treatment for the developing child. Neonatal prostheses allow for normal feeding and help to direct proper tongue position. Palatal obturation is essential during all growth and tooth development. When orthodontic treatment is necessary and a pharyngeal extension prosthesis is present, obturation can be maintained with flexible denture liners. Each individual situation will allow utilization of an innovative type of prosthesis.