Clinical Review Fortnightly review

Periodontitis for medical practitioners

BMJ 1998; 316 doi: (Published 28 March 1998) Cite this as: BMJ 1998;316:993
  1. Trevor L P Watts (, senior lecturer in periodontology
  1. Department of Periodontology and Preventive Dentistry, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SE1 9RT
  1. Correspondence to: Dr Watts
  • Accepted 28 October 1997

Periodontitis is largely excluded from medical education, but general practitioners may well be consulted by patients who have this condition. Periodontitis is one of the best researched dental diseases; Medline lists 33 000 papers published under the heading Periodontal diseases between 1966 and 1996. However, misconceptions about periodontitis abound (box), some of which are perpetuated by medical correspondents in the national press. A basic understanding of the condition and of evidence based treatment will help general practitioners ensure that patients are not given misleading advice.

Summary points

Periodontitis is primarily a disease of the periodontal ligament, not of bone

Bacterial plaque is the main cause of periodontitis

Smoking and diabetes are the principal exacerbating factors

Periodontitis is associated with a complex microbial environment

Success of treatment depends on the control of bacterial plaque; antimicrobial drugs have only an adjunctive role in a full treatment plan


This review is based on 25 years of undergraduate and postgraduate teaching of the subject. Selection of the few references from the huge number available is inevitably biased, and is intended to illustrate certain key points, but the views given are widely held consensus opinions.

Periodontitis—scene and the crime

On a tooth with healthy gingiva, inflammation caused by developing bacterial plaque occurs within 5-20 days. The junction between the tooth and the jaw (fig 1) is covered by epithelium that has a high turnover1 and is permeable to neutrophils and many molecules. Beneath the epithelium is the organ that may have the body's fastest turnover of collagen—the periodontal ligament. Fibres of the periodontal ligament are anchored in the thin cementum on the tooth root at one end and in alveolar bone or soft gingival connective tissue at the other. The tooth does not have to be anchored in bone for it to be clinically healthy, fully functional, and free from …

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