Intended for healthcare professionals

Clinical Review ABC of oral health

Periodontal disease

BMJ 2000; 321 doi: (Published 01 July 2000) Cite this as: BMJ 2000;321:36

This article has a correction. Please see:

  1. John Coventry,
  2. Gareth Griffiths,
  3. Crispian Scully,
  4. Maurizio Tonetti

    Most periodontal disease arises from, or is aggravated by, accumulation of plaque, and periodontitis is associated particularly with anaerobes such as Porphyromonas gingivalis, Bacteroides forsythus, and Actinobacillus actinomycetemcomitans. Calculus (tartar) may form from calcification of plaque above or below the gum line, and the plaque that collects on calculus exacerbates the inflammation. The inflammatory reaction is associated with progressive loss of periodontal ligament and alveolar bone and, eventually, with mobility and loss of teeth.

    Chronic marginal gingivitis showing erythematous oedematous appearance

    Periodontal diseases are ecogenetic in the sense that, in subjects rendered susceptible by genetic or environmental factors (such as polymorphisms in the gene for interleukin 1, cigarette smoking, immune depression, and diabetes), the infection leads to more rapidly progressive disease. Osteoporosis also seems to have some effect on periodontal bone loss.

    Gingivitis with hyperplasia

    The possible effects of periodontal disease on systemic health, via pro-inflammatory cytokines, have been the focus of much attention. Studies to test the strength of associations with atherosclerosis, hypertension, coronary heart disease, cerebrovascular disease, and low birth weight, and any effects on diabetic control, are ongoing.


    Chronic gingivitis to some degree affects over 90% of the population. If treated, the prognosis is good, but otherwise it may progress to periodontitis and tooth mobility and loss. Marginal gingivitis is painless but may manifest with bleeding from the gingival crevice, particularly when brushing the teeth. The gingival margins are slightly red and swollen, eventually with mild gingival hyperplasia.

    • Good oral hygiene is essential both in preventing and treating periodontal disease

    • Antimicrobial drugs have no place in treating chronic gingivitis

    Management—Unless plaque is assiduously removed and kept under control by tooth brushing and flossing and, where necessary, by removal of calculus by scaling and polishing by dental staff, the condition will recur. Although gingivitis …

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