PERIODONTAL DISEASES - A CLINICIAN'S GUIDE Edited by Jane Manakil Periodontal Diseases - A Clinician's Guide Edited by Jane Manakil Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Ivona Lovric Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published January, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Periodontal Diseases - A Clinician's Guide, Edited by Jane Manakil p. cm. ISBN 978-953-307-818-2 Contents Preface IX Part 1 Aetiology of Periodontal Diseases 1 Chapter 1 The Microbial Aetiology of Periodontal Diseases 3 Charlene W.J. Africa Chapter 2 Microbiological Diagnosis for Periodontal Diseases 55 Akihiro Yoshida and Toshihiro Ansai Part 2 Pathogenesis of Periodontal Diseases 67 Chapter 3 Periodontal Disease and Gingival Innate Immunity – Who Has the Upper Hand? 69 Whasun Oh Chung and Jonathan Y. An Chapter 4 The Impact of Bacteria-Induced Adaptive Immune Responses in Periodontal Disease 93 Vincent K. Tsiagbe and Daniel H. Fine Chapter 5 Effects of Smoking and Smoking Cessation and Smoking Cessation Intervention 107 T. Hanioka, M. Ojima and M. Nakamura Part 3 Relationship Between Periodontal Disease and Systemic Health 129 Chapter 6 The Emerging Concepts on the Impact of Periodontitis on Systemic Health 131 S. Anil, S. V. Varma, R.S. Preethanath, P. S. Anand and A. Al Farraj Aldosari Chapter 7 Systemic Effects of Periodontal Diseases: Focus on Atherosclerosis 165 Emil Kozarov and John Grbic VI Contents Chapter 8 Diabetes Mellitus Impact on Periodontal Status in Children and Adolescents 179 Liliana Foia, Vasilica Toma and Petra Surlin Chapter 9 One for All™: How to Tackle with Diabetes, Obesity and Periodontal Diseases 197 Ayse Basak Cinar Part 4 Epidemiological Studies of Periodontal Disease 211 Chapter 10 Epidemiology and Risk Factors of Periodontal Disease 213 Amin E. Hatem Chapter 11 Periodontal Diseases in Greek Senior Citizens-Risk Indicators 231 Eleni Mamai-Homata, Vasileios Margaritis, Argy Polychronopoulou, Constantine Oulis and Vassiliki Topitsoglou Chapter 12 Epidemiology: It’s Application in Periodontics 253 Surajit Mistry, Debabrata Kundu and Premananda Bharati Chapter 13 Periodontal Diseases in Anthropology 279 Hisashi Fujita Part 5 Treatment of Periodontal Disease 295 Chapter 14 Present and Future Non-Surgical Therapeutic Strategies for the Management of Periodontal Diseases 297 Renata S. Leite and Keith L. Kirkwood Chapter 15 Laser Radiation as an Adjunct to Nonsurgical Treatment of Periodontal Disease 317 Juan Antonio García Núñez, Alicia Herrero Sánchez, Ana Isabel García Kass and Clara Gómez Hernández Part 6 Periodontium and Aging 341 Chapter 16 Effects of Human Ageing on Periodontal Tissues 343 Eduardo Hebling Chapter 17 Aging, Oral Health and Quality of Life 357 Vinicius Cappo Bianco and José Henrique Rubo Preface “Periodontal diseases” is a comprehensive web-based resource on different aspects of periodontal conditions: recognition, microbial aetiology, immunopathogenesis, modifying factors, diagnosis, and treatment of periodontal diseases in the practice of dentistry. The aim of this book is to provide an amalgamated content containing of evidence-based reviews and research on the recent advances in periodontal diseases. This multifaceted web-resource has utilized the collaboration of numerous specialists and researchers from around the world to integrate the elaborate number of topics within the subject area of periodontal diseases. Although an attempt at a comprehensive coverage of aetiology, pathogenesis and clinical concepts has been made, due to time and space limitations we were not able to cover the vast array of research studies that is still being done in the field of periodontal diseases. The topics covered are either research studies or reviews on the following topics: Aetiology of the periodontal diseasesPathogenesis of periodontal diseases Relationship between periodontal diseases and systemic health Epidemiology of periodontal diseases Anthropology and periodontal diseases with focus on the Jomon people in Japan Treatment of periodontal diseases Periodontium and aging The information presented in this publication is intended to reach the contemporary practitioners, as well as educators and students in the field of periodontology. It is fully searchable and designed to enhance the learning experience. The content is produced to challenge the reader and provide clear information. This book provides a unique insight into the various emerging concepts in periodontal diseases from an international perspective. Furthermore, there is research-based material on the role of molecular factors such as the cytokines, proteases and protease inhibitors, and the role of epigenetic status in health and disease. Many patients with the same clinical symptoms respond differently to the same therapy, suggesting the inter-individual variability observed as a clinical outcome of the disease is influenced by genetic as well as epigenetic factors. There is a contemporary insight into the oral innate and adaptive immune responses X Preface with elucidation into the development of potential innovative therapeutic interventions for periodontal disease. Mounting evidence is available indicating periodontitis as a risk factor for various systemic diseases such as cardiovascular diseases, diabetes mellitus, osteoporosis, hematologic disorder, immune system disorders, gastrointestinal disorders, rheumatoid arthritis, pulmonary diseases and adverse effects in pregnancy. Several mechanisms have been proposed here to explain how periodontal disease initiated by microorganisms in the dental plaque and host modulation can contribute to the development of cardiovascular diseases and bidirectional effects in diabetes mellitus, rheumatoid arthritis. Risk factors, such as smoking, genetics, stress and increasing age, could independently lead to periodontal disease and to cardiovascular disease. There is an increase in the amount of research being performed on genetic susceptibility to periodontal disease influenced by exposure to smoking or the effect of smoking on periodontal disease as a bilateral modulating factor. Another chapter in this book presents an epidemiological investigation into the periodontal and oral hygiene status, measured according to socio-demographic and behavioural parameters in different populations, and comparative analysis. This contribution emphasizes the need for dental practitioners as well as dental public health policy makers to work towards equity in oral health and focus not only on dental characteristics but also on the life characteristics of older adults, and on their quality of life issues. A variety of pharmacological treatment strategies is reviewed here in addition to SRP, involving antimicrobials to chemo mechanics developed to target the host response to LPS-mediated tissue destruction and MMP Inhibitors in the treatment of periodontitis. In the last decades, laser therapy has been proposed as an alternative or as a complement to conventional non-surgical therapy, due to its capability to obtain tissue ablation and haemostasis, bactericidal effect against periodontal pathogens and detoxification of root surface. Several studies have reported the use of PDT therapy as an addition to nonsurgical treatment for initial and supportive therapy of chronic periodontitis. A deliberation of modern treatment strategies to manage periodontitis has been considered here, which is a challenging field of on-going research. Dr. Jane Manakil, School of Dentistry and Oral Health Faculty of Health Gold Coast campus, Griffith University, Australia . Surajit Mistry, Debabrata Kundu and Premananda Bharati Chapter 13 Periodontal Diseases in Anthropology 279 Hisashi Fujita Part 5 Treatment of Periodontal Disease 295 Chapter 14 Present and. Charlene W.J. Africa Chapter 2 Microbiological Diagnosis for Periodontal Diseases 55 Akihiro Yoshida and Toshihiro Ansai Part 2 Pathogenesis of Periodontal Diseases 67 Chapter 3 Periodontal. Status in Children and Adolescents 179 Liliana Foia, Vasilica Toma and Petra Surlin Chapter 9 One for All™: How to Tackle with Diabetes, Obesity and Periodontal Diseases 197 Ayse Basak Cinar