Periodontitis

The literature describes periodontitis as initiated by bacteria in the oral biofilm, with dysbiosis of the local microbial community triggering local inflammation. It is also described as a complex disease in which multiple causative factors interact, including aberrant host responses and disturbances in the balance between the host and the oral microbiome.

Periodontitis involves a host inflammatory and immune cascade that is triggered by oral biofilm bacteria and sustained when acute inflammation fails to resolve. Over-activation of innate and acquired immune pathways, including cytokine-mediated responses, contributes to recruitment of immune cells, osteoclastic activity, and loss of alveolar bone and soft tissue.

Diabetes is a major risk factor, with susceptibility increased in people with diabetes and severity linked to the degree of hyperglycaemia. The literature also supports susceptibility being influenced by the magnitude and quality of the host inflammatory response, including inherited or acquired abnormalities in immune responsiveness and inflammatory resolution.

The supplied grounding supports treatment at the level of therapy, drug therapy, prevention and control, and diagnosis, but does not provide specific treatment modalities or drug classes. It does indicate that management is discussed in relation to controlling inflammation and host response, alongside diagnosis and prevention, but not enough detail is given to state a standard of care.