J Health Care Dent. 2004; 6: 23-41 Printed in Japan. All rights reserved * Reconsideration of Diagnosis, Treatment and Maintenance of Periodontal Disease Periodontitis is different from other infectious diseases, because it is an inflammatory disease with a unique feature of periodontopathic bacteria colonizing in the exterior portion of the soft tissues in many cases. The local host resistance and reaction to the bacteria triggers the expression of the disease. We evaluated mrna levels of the cytokines, and our study indicates that with the increase in the severity of clinical findings the levels of the cytokines (IL-1 IL-6, and TNF ), potent stimulator of bone resorption, maintain high in the local sites. In order to understand periodontitis, we need to have a better understanding of commonly called Constitution as well as bacteria. The interindividual difference of 1 codogenic (1 base) (more than 1% frequency of the population) is called as polymorphism, and this codogenic difference prescribes the constitution. Kornman et al demonstrated in their study that there is a correlation between IL-1 genotype and severity of periodontitis. About 30 % of the Caucasians and about 7-10% of the Japanese are IL-1 genotype positive group. Thus, there are controllable risk factors of periodontitis, such as plaque accumulation, and uncontrollable risk factors. We think that it will become more important to offer a patient a preventive program of periodontitis by objectively evaluating his/her risk factors. The purpose of this review is to describe the significance of the classification of periodontitis developed by AAP and a workflow of diagnosis and treatment of periodontitis within its scope, subject to the understanding of periodontitis. J Health Care Dent. 2004; 6: 23-41. Shinya MURAKAMI, DDS, PhD 1-8 Professor, Department of Periodontology, Osaka University, Graduate School of Dentistry 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan periodontal diseases diagnosis periodontal treatment maintenance polymorphism IL-1 gerotype positive classification 1 1-1 11 15 24 8 common disease 21 1 * 2004 2
1 2 3 1 21 2 MURAKAMI
3 4 1999 4 4 IL-1 interleukin-1
MURAKAMI 5 needle punch biopsy mrna gingival index IL-1 IL-6 TNF 5 1990 21 22 2005 1998 2001 2000 6 1 3600 3 1000 2
SNP single nucleotide polymorphism 1 1 1 IL-1 100 100 1 300 SNP IL-1 SNP IL-1 100 IL-1 IL-1 3 7 10 IL-1 1997 Kornman IL-1 IL-1 IL-1 IL- 1 1-2 AAP 35 35 35 35
MURAKAMI I. 1 2 3 4 1 2 3 4 5 6 7 8 II. III. A B A B 1 IV. 1999 A B V. A NUG B NUP VI. A B C VII. A - VIII. A / B C D 2 1 2 3 4 5 6 7-8 1999 1 2
3 Chronic Periodotitis A. 30 B. 30 HIV 55 6 3 attachment loss 6 7 55
MURAKAMI 4 Agressive Periodotitis A. attachment loss 2 B. 3 famillial aggregation A.a. P.g. 29 20 4 familial aggregation Actinobacillus actino-
5 Periodontitis as a Manifestation of Systemic Diseases A. 1 2 3 B. 1 2 3 4 Papillon-Lefèvre 5 Chédiak-Higashi 6 7 8 9 Cohen 10 Ehiers-Danlos IV VIII 11 12 C. mycetemcomitance A.a. P.g. A.a. Porphyromonas gingivalis P.g. 8 9 29 1 5 2 2-1
MURAKAMI SPT supportive periodon-tal therapy definitive curettage 2-2 5 14 15 24 1 156 6 GI 6 6 2mm 5 8 GI1 2 P.g. 2-3 AAP
6 IDDM Type1 Diabetes Mellitus 30 NIDDM Type2 40 95 10 42 5391 1999 HIV HIV AIDS T HIV HIV HIV 1 2 6 2 10 Neison et al., 1990 4 2 15 54 1342 11 1 27 12 2 52 2
MURAKAMI 1 2 2002
13 X 2 14 2 2 TNF 8 TNF TNF 15 H D IL-1 TNF
MURAKAMI IL-1 TNF BMI 18.5 25 18.5 25 BMI 1 1.7 3.4 8.6 TNF 7 A 16
7 50 60 Ca 2 A 30 16 50 2002 3 3-1 40 75 11 13 55 59 10 20
MURAKAMI 17-1 Axelsson P & Lindhe J: J Clin Periodontol, 8(4): 281-294, 1981. 17-2 17-3 attachment level 3-2 2 3 17-1 17-2 3 6 17-2 17-3 17-3
Supportive Periodontal Therapy SPT 3-3 SPT definitive curettage SPTsupportive periodontal therapy supportive periodontal treatment 1 SPT SPT 1 3 3 recolonization)
MURAKAMI definitive curettage SPT SPT definitive curettage Schluger 1990 1 2 caries activity caries 3 definitive curettage 3 SPT 100 SPT definitive curettage SPT definitive curettage definitive curettage definitive curettage M2 M3 definitive curettage definitive curettage
Axelsson P & Lindhe J: The significance of maintenance care in the treatment of periodontal disease. J Clin Periodontol, 8(4): 281-294, 1981. Emrich LJ, Shlossman M, Genco RJ: Periodontal disease in noninsulin-dependent diabetes mellitus. J Periodontol, 62(2): 123-131, 1991. Kornman KS, Crane A, Wang HY et al.: The interleukin-1 genotype as a severity factor in adult periodontal disease. J Clin Periodontol, Jan; 24(1): 72-77, 1997. Schluger S, Yuodelis R, Page R et al.: Periodontal Diseases. Lea & Febiger, Philadelphia, 1990. AAP 2001 42 5 391 1999 1999 2002