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Clinical Microbiology Reviews, October 2001, p. 727-752, Vol. 14, No. 4
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.4.727-752.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Periodontal Disease as a Specific, albeit Chronic, Infection: Diagnosis and Treatment

Walter J. Loesche1,2,* and Natalie S. Grossman2

School of Dentistry2 and Department of Microbiology and Immunology, School of Medicine,1 University of Michigan, Ann Arbor, Michigan 48109

Periodontal disease is perhaps the most common chronic infection in adults. Evidence has been accumulating for the past 30 years which indicates that almost all forms of periodontal disease are chronic but specific bacterial infections due to the overgrowth in the dental plaque of a finite number of mostly anaerobic species such as Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola. The success of traditional debridement procedures and/or antimicrobial agents in improving periodontal health can be associated with the reduction in levels of these anaerobes in the dental plaque. These findings suggest that patients and clinicians have a choice in the treatment of this overgrowth, either a debridement and surgery approach or a debridement and antimicrobial treatment approach. However, the antimicrobial approach, while supported by a wealth of scientific evidence, goes contrary to centuries of dental teaching that states that periodontal disease results from a "dirty mouth." If periodontal disease is demonstrated to be a risk factor for cardiovascular disease and stroke, it will be a modifiable risk factor since periodontal disease can be prevented and treated. Since the antimicrobial approach may be as effective as a surgical approach in the restoration and maintenance of a periodontally healthy dentition, this would give a cardiac or stroke patient and his or her physician a choice in the implementation of treatment seeking to improve the patient's periodontal condition so as to reduce and/or delay future cardiovascular events.

* Corresponding author. Mailing address: School of Dentistry, University of Michigan, 3211 Dentistry, 1011 N. University Ave., Ann Arbor, MI 48109. Phone: (734) 764-8386. Fax: (734) 647-2110. E-mail: Wloesche{at}umich.edu.

Clinical Microbiology Reviews, October 2001, p. 727-752, Vol. 14, No. 4
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.4.727-752.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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Copyright © 2001 by the American Society for Microbiology. All rights reserved.