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Review Article z Available online at http://www.journalcra.com INTERNATIONAL JOURNAL OF CURRENT RESEARCH International Journal of Current Research Vol. 7, Issue, 11, pp.22644-22649, November, 2015 ISSN: 0975-833X REVIEW ARTICLE CLASSICAL CONCEPTS OF PERIODONTOLOGY Dr. Harjit Kaur, Dr. Sanjeev Jain, *Dr. Radhika Kamboj, and Dr. Gaurav Pandav Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India ARTICLE INFO ABSTRACT Article History: The maturity of a scientific discipline is marked by knowledge of its roots, knowledge of evolution of Received 16th August, 2015 concepts from ancient times to present and an intelligent look into the future. Newer thoughts have Received in revised form been superimposed on the matrix of older ideas. The important discoveries and decisions of past 21st September, 2015 centuries became the springboard for inventions and advances of the field in coming centuries. So, Accepted 09th October, 2015 periodontology in modern era presents the blend of the thoughts from the times periodontal disease Published online 30th November, 2015 was first noticed in history. This review article is intended to compile the various concepts regarding etiology, pathogenesis and treatment of periodontal diseases that changed with time and gave rise to Key words: present concepts and also provide a view of future possibilities. Periodontal Disease, Periodontology, Concepts. Copyright © 2015 Dr. Harjit Kaur et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Dr. Harjit Kaur, Dr. Sanjeev Jain, Dr. Radhika Kamboj, and Dr. Gaurav Pandav, 2015. “Classical concepts of periodontology”, International Journal of Current Research, 7, (11), 22644-22649. INTRODUCTION The Localist group: For the ease of simplification the local- Periodontology is the scientific study of the periodontium in cause theory can be summarized into four axioms as follows health and disease (Glossary of Periodontal terms, 2001). (formulated over two centuries ago) Periodontal diseases have plagued humans and their phylogenetic ancestors for a very long time. Since the times Periodontal disease is independent of systemic disease history first mentioned periodontal disease, the concepts manifestations. regarding etiology, pathogenesis, treatment and prevention of Periodontal disease had a local etiology or accidental origin periodontal diseases are in a state of flux (Tatakis and Kumar, occasioned by teeth and no internal or general cause. 2005). In a sense, the newest or dominant concepts rest on a Local, intraoral interventions can prevent and successfully foundation of the still valid components of the older or treat periodontal disease. previous thoughts. As said, Local treatments can provide systemic health benefits. “Change is one thing, progress is another, The generalists camp: The generalists said that systemic Change is scientific, progress is ethical, conditions were the immediate cause of periodontal Change is indubitable whereas progress is a matter of disturbances. They hypothesized that primary cause of controversy.” periodontal disease are remote from the oral cavity and are -Bertrand Russell only amenable to chronic disease management unless the remote cause are pinpointed and intervented upon (Hujoel et With all this, the article aims to bring together the classical al., 2000). However, Irving Glickman in 1959 considered that concepts of periodontology regarding etiology, pathogenesis, these two factors are actually interrelated. He concluded that treatment and prevention of periodontal diseases. gradations in the proportion of local and systemic disease causing factors determine the nature and course of periodontal CLASSICAL CONCEPTS OF ETIOLOGY disease. The basic concept of etiology of periodontal diseases consisted Over the coming decades, periodontal disease became more of two camps namely: the “localists” and the “generalists” or redefined as an infectious disease and Harold Loe in 1960s “constitutional” camps (Hujoel et al., 2000). provided experimental evidence for a direct relationship between the presence of dental bacterial plaque and gingivitis *Corresponding author: Radhika Kamboj, which affected most aspects of clinical periodontology PG Student Department of Periodontology, India. prevailing at that time (Theilade et al., 1966). 22645 Dr. Harjit Kaur et al. Classical concepts of periodontology Sigmund Socransky in 1970 further advocated that periodontal The susceptible host infections are caused by organised communities of bacteria in The presence of pathogenic species which some microorganisms are more important than others The absence/small proportion of beneficial bacteria from an etiologic perspective and this belief made Walter Loeshce in 1976 to advocate the ‘Specific Plaque hypothesis’ CLASSICAL CONCEPTS OF PATHOGENESIS over the ‘Non Specific hypothesis’ (Loesche, 1976). From the pages of history we now know that the concepts of The non specific hypothesis describes that the periodontal etiology of periodontal diseases shuffled with time, and the disease results from the “elaboration of noxious products same happened with the concepts of pathogenesis of produced by the entire plaque flora”. The Specific plaque periodontal disease. The prehistoric era had little knowledge concept predicts that the plaque harbouring specific bacterial about the mechanism of periodontal diseases. The early pathogens results in a periodontal disease because these assumptions held that disease or injury was a deserved evil organisms produce substances that mediate the destruction of visited upon an individual by the deity for infarctions in host tissues (Teughels et al., 2012). However, Marsh and co- thought or deed (Gold, 1985). In 1728 Pierre Fauchard workers in 1990s gave the ecologic plaque hypothesis which recognized the relationship between oral hygiene and the states that both the amount of dental plaque and the specific etiology and wrote: microbial composition contribute to the transition from heath to periodontal disease. "Little or no care as to the cleanliness of the teeth is ordinarily the cause of the maladies that destroy them." By 1987 the majority of clinicians and authors accepted the concept that most forms of destructive periodontal disease But with time the developments in the medical and technical followed the Infection-Host Response paradigm. In summary, fields opened new methods to understand the disease during (1962-1987) the important concepts in periodontal mechanism. In the 18th century, the first scientific studies were etiology were as follows: presented by Morgagni GB and Bichat that hinted the correlation between clinical symptoms and autopsy findings. Chronic gingivitis and experimental gingivitis appear to be Morgagni’s descriptions clearly distinguished the important inflammatory reactions to qualitative changes in the findings from the significant details, presenting the clinical composition of dental plaque at affected sites. signs and symptoms, the treatment performed, and the autopsy Only a small percentage of sites with untreated chronic findings with an interpretation of their relationship to the gingivitis progress to periodontitis. This progression is not clinical picture. Bichat’s contribution was to extend the inevitable. Morgagni’s concept of organ pathology to the organ The progression of periodontitis, or the development of constituents, namely the tissues. He discovered that organs are increased clinical attachment loss, appears to be episodic or made out of tissues and that the tissues are the origin of occurs in bursts. pathological changes (Merrit, 1921). Periodontosis (juvenile periodontitis) was shown to be an infection and not a degenerative condition. In the 19th century, three major developments in medical The most common form of destructive periodontitis (i.e. science had a particular impact on Periodontics: 1. chronic inflammatory periodontitis) is a group of infections Discovery of anaesthesia, 2. Development of germ theory caused by dental plaque in susceptible individuals. of disease, and 3. Discovery of X rays. The concept emerged that a relatively small number of During those days periodontal pathogenesis was dominated specific bacteria appear to be the main etiologic agents of by the premise that local factors lead to the destruction of adult periodontitis. periodontal tissues. Researchers believed that most of the Hard and soft tissue damage observed in periodontal destruction of periodontal tissues during the course of the disease was primarily caused by inflammatory and disease was due to inflammatory or degenerative/atrophic immunologic host responses to infecting agents (Armitage, processes. Until the late 1960s, researchers based their 2000). studies primarily on observations and individual interpretations of the histologic changes in the diseased From 1990 to 2012 most of the research dealing with the tissues. conceptual issues in periodontal etiology focused on In the 1960s, the major development was the demonstration confirmation of the concepts that were introduced during two that bacteria in dental plaque cause human gingivitis and and a half decades from 1962-1990. In 2012, the prevailing periodontitis. concepts in periodontal etiology were essentially the same as In the 1970s, specific species of predominantly gram- those were followed
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