Preface

Preface
IRAB. LAMSTER
The diagnosis of periodontal disease has relied on clinical and radiographic parameters for many years. The proper use of the periodontal probe, and well aligned and exposed bitewing and periapical radiographs provide the clinician with an accurate measurement of the amount of nonmineralized and mineralized tissue destruction that has occurred in the past. These measures, which were introduced more than 50 years ago, continue today as the basis for periodontal diagnosis in clinical practice. During the early 1980s, longitudinal clinical studies demonstrated that long-held concepts concerning the natural history of periodontal disease required modification. The progression of periodontitis in humans was not slow and constant but, similar to other chronic diseases, was characterized by periods of exacerbation and remission (1, 2 ) . More recent studies have suggested that different patterns of disease progression may exist in patients with adult periodontitis (3). Consequently, a reevaluation of how we diagnose patients with periodontal disease was in order. This has led to the following conclusions: First, we now recognize that patients can be assessed for both disease severity (existing tissue destruction) and their risk for disease activity (the future progression of periodontal disease as determined by probing attachment loss or new loss of alveolar bone), and these two assessments are not equivalent. Second, as standard clinical and radiographic measures of periodontal disease are poor predictors of the risk for future disease (4-61, the identification of the risk for disease activity will rely on other parameters. Third, probing depth and radiographic bone loss measurements are undergoing modification for improved accuracy and the ability to detect disease progression over time. Automated probes are now available to standardize probing force and to automatically record and retrieve clinical findings. Subtraction radiography provides a means of detecting subtle changes in the height of alveolar bone. These devices and techniques are used in research settings but have not yet found their way to clinical practice. Fourth, a new approach to diagnosis of periodontal disease has been proposed that relies on the identification of the microbial challenge and the host response to that challenge. This conceptual change has as its focus the early detection of disease. These changes in the approach to diagnosis of periodontal disease can be compared with changes that have been introduced in other biomedical disciplines. For example, cardiovascular medicine relies on the stethoscope as an important tool in evaluating a patient with suspect cardiac disease, but a variety of newer radiographic techniques (such as cardiac imaging using radionuclide angiocardiography) and biochemical measures (such as the lipoprotein profile in serum) offer an improved understanding of the nature, progression and risk of future disease. Nevertheless, as new procedures are introduced in periodontology during these times of cost containment in health care, practitioners must use caution in deciding which patients would benefit from a comprehensive evaluation. This volume begins with a historical review of periodontal diagnosis, but the theme of the monograph is new approaches to patient evaluation. The concluding chapter addresses how diagnostic tests for periodontal disease are evaluated and reviews the concept of risk assessment for periodontal disease. The chapters in this volume highlight the advances in diagnosis that have occurred over the past few years. This new paradigm for periodontal diagnosis will result in more specific evaluation of patients and will lead to therapy that is directed towards the individual needs of those who seek care.
References
1. Goodson JM, Tanner ACR, Haffajee AD, Sornberger GC,
Socransky SS. Patterns of progression and regression of advanced destructive periodontal disease. J Clin Periodontol 1982: 9: 472481. 2. Socransky SS, Haffajee AD, Goodson JM, Lindhe J. New
concepts of destructive periodontal disease. J Clin Periodontol 1984: 11: 21-32. 3. Jeffcoat MK, Reddy MS. Progression of probing attachment loss in adult periodontitis. J Periodontol 1991: 62: 185-189. 4. Haffajee AD, Socransky SS, Goodson JM. Clinical parameters as predictors of destructive periodontal disease activity. J Clin Periodontol 1983: 10: 257-265.
5. Baderstein A, Nilveus R, Egelberg J. Effect of nonsurgical
periodontal therapy. VII. Bleeding, suppuration and probing depth in sites with probing attachment loss. J Clin Periodontol 1985: 12: 432-440. 6. Lang NE: Adler R, Joss A, Nyman S. Absence of bleeding on probing: an indicator of periodontal stability. J Clin Periodontol 1990: 17: 714-721.

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5. Baderstein A, Nilveus R, Egelberg J. Effect of nonsurgical

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