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The monthly reevaluation of periodontal therapy should involve periodontal charting as a better indication of the success of treatment, and to see if other courses of treatment can be identified. Pocket depths of greater than 5–6 mm (0.20–0.24 in) which remain after initial therapy, with bleeding upon probing, indicate continued active ...
Chronic periodontitis is initiated by Gram-negative tooth-associated microbial biofilms that elicit a host response, which results in bone and soft tissue destruction. In response to endotoxin derived from periodontal pathogens, several osteoclast-related mediators target the destruction of alveolar bone and supporting connective tissue such as the periodontal ligament.
Necrotizing periodontal diseases are non-contagious infections but may occasionally occur in epidemic-like patterns due to shared risk factors. The milder form, necrotizing ulcerative gingivitis (also termed "trench mouth"), [ 9 ] is characterized by painful, bleeding gums and ulceration and necrosis of the interdental papilla .
Dental plaque bacteria have been linked to cardiovascular disease [25] and mothers giving birth to pre-term low weight infants, [26] but there is no conclusive evidence yet that periodontitis is a significant risk factor for either of these two conditions. [27]
Smoking cessation (if applicable): Smoking is a significant risk factor for AgP, with patients who smoke having more affected teeth with loss of clinical attachment and more bone loss than non-smoking patients with AgP. [48] Non-smokers also tend to have a better response to periodontal therapy as compared to smokers.
Risk characteristics must be considered in conjunction with risk factors as variables that may also contribute to increasing or decreasing one's chances of developing periodontal disease. Numerous studies show that age, gender , race , socioeconomic status , education and genetics also have strong relationships on influencing periodontal disease.
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The use of tobacco may also increase the risk for caries formation. Some brands of smokeless tobacco contain high sugar content, increasing susceptibility to caries. [53] Tobacco use is a significant risk factor for periodontal disease, which can cause the gingiva to recede. [54]