Skip to main content
NCBI home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1993 Nov 15;149(10):1409–1422.

Periodic health examination, 1993 update: 3. Periodontal diseases: classification, diagnosis, risk factors and prevention. Canadian Task Force on the Periodic Health Examination.

A I Ismail 1, D W Lewis 1
PMCID: PMC1485890  PMID: 8221425

Abstract

OBJECTIVE: To review the 1979 Canadian Task Force on the Periodic Health Examination recommendations on the diagnosis and prevention of periodontal disease. OPTIONS: Self-care at home, professional care, treatment with antimicrobial agents and management of patients at high risk. OUTCOMES: Maintaining the gingiva, alveolar bone and periodontal ligament in a healthy state (absence of gingival bleeding and no loss of epithelial attachment). EVIDENCE: A literature search for articles published from 1980 to 1993 was conducted. Selected studies published before 1980 were also reviewed if there were no recent updates. Evidence was evaluated and classified as good, fair or poor according to the criteria of the task force. VALUES: The task force's evidence-based rules for recommendations were used. In addition, whenever feasible, and on the basis of advice from the reviewers and experts, recommendations were modified in the interest of maintaining oral health (e.g., dental flossing in children). BENEFITS, HARMS AND COSTS: The recommendations are not expected to increase the costs of preventing periodontal diseases for the general population. They could benefit dental patients and reduce costs because they are based on the periodontal needs of patients rather than on the current universal application approach.

Full text

PDF
1409

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abdellatif H. M., Burt B. A. An epidemiological investigation into the relative importance of age and oral hygiene status as determinants of periodontitis. J Dent Res. 1987 Jan;66(1):13–18. doi: 10.1177/00220345870660010201. [DOI] [PubMed] [Google Scholar]
  2. Addy M., Dummer P. M., Hunter M. L., Kingdon A., Shaw W. C. The effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque, gingivitis and pocketing in adolescents: a longitudinal cohort study. Community Dent Health. 1990 Sep;7(3):237–247. [PubMed] [Google Scholar]
  3. Albandar J. M., Olsen I. Nucleic acid probes as potential tools in oral microbial epidemiology. Community Dent Oral Epidemiol. 1990 Apr;18(2):88–94. doi: 10.1111/j.1600-0528.1990.tb00025.x. [DOI] [PubMed] [Google Scholar]
  4. Anerud A., Löe H., Boysen H. The natural history and clinical course of calculus formation in man. J Clin Periodontol. 1991 Mar;18(3):160–170. doi: 10.1111/j.1600-051x.1991.tb01128.x. [DOI] [PubMed] [Google Scholar]
  5. Appelgren R., Robinson P. J., Kaminski E. J. Clinical and histologic correlation of gingivitis. J Periodontol. 1979 Oct;50(10):540–543. doi: 10.1902/jop.1979.50.10.540. [DOI] [PubMed] [Google Scholar]
  6. Axelsson P., Lindhe J. Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. J Clin Periodontol. 1978 May;5(2):133–151. doi: 10.1111/j.1600-051x.1978.tb01914.x. [DOI] [PubMed] [Google Scholar]
  7. Axelsson P., Lindhe J., Nyström B. On the prevention of caries and periodontal disease. Results of a 15-year longitudinal study in adults. J Clin Periodontol. 1991 Mar;18(3):182–189. doi: 10.1111/j.1600-051x.1991.tb01131.x. [DOI] [PubMed] [Google Scholar]
  8. Baab D. A., Johnson R. H. The effect of a new electric toothbrush on supragingival plaque and gingivitis. J Periodontol. 1989 Jun;60(6):336–341. doi: 10.1902/jop.1989.60.6.336. [DOI] [PubMed] [Google Scholar]
  9. Baelum V., Fejerskov O., Manji F. Periodontal diseases in adult Kenyans. J Clin Periodontol. 1988 Aug;15(7):445–452. doi: 10.1111/j.1600-051x.1988.tb01599.x. [DOI] [PubMed] [Google Scholar]
  10. Baelum V., Fejerskov O. Tooth loss as related to dental caries and periodontal breakdown in adult Tanzanians. Community Dent Oral Epidemiol. 1986 Dec;14(6):353–357. doi: 10.1111/j.1600-0528.1986.tb01090.x. [DOI] [PubMed] [Google Scholar]
  11. Baer P. N. The case for periodontosis as a clinical entity. J Periodontol. 1971 Aug;42(8):516–520. doi: 10.1902/jop.1971.42.8.516. [DOI] [PubMed] [Google Scholar]
  12. Bailit H. L., Braun R., Maryniuk G. A., Camp P. Is periodontal disease the primary cause of tooth extraction in adults? J Am Dent Assoc. 1987 Jan;114(1):40–45. doi: 10.14219/jada.archive.1987.0052. [DOI] [PubMed] [Google Scholar]
  13. Beacham B. E., Kurgansky D., Gould W. M. Circumoral dermatitis and cheilitis caused by tartar control dentifrices. J Am Acad Dermatol. 1990 Jun;22(6 Pt 1):1029–1032. doi: 10.1016/0190-9622(90)70146-9. [DOI] [PubMed] [Google Scholar]
  14. Bergström J., Eliasson S. Cervical abrasion in relation to toothbrushing and periodontal health. Scand J Dent Res. 1988 Oct;96(5):405–411. doi: 10.1111/j.1600-0722.1988.tb01575.x. [DOI] [PubMed] [Google Scholar]
  15. Bergström J., Eliasson S. Noxious effect of cigarette smoking on periodontal health. J Periodontal Res. 1987 Nov;22(6):513–517. doi: 10.1111/j.1600-0765.1987.tb02364.x. [DOI] [PubMed] [Google Scholar]
  16. Best A. M., Burmeister J. A., Gunsolley J. C., Brooks C. N., Schenkein H. A. Reliability of attachment loss measurements in a longitudinal clinical trial. J Clin Periodontol. 1990 Sep;17(8):564–569. [PubMed] [Google Scholar]
  17. Bouma J., Schaub R. M., van de Poel F. Relative importance of periodontal disease for full mouth extractions in the Netherlands. Community Dent Oral Epidemiol. 1987 Feb;15(1):41–45. doi: 10.1111/j.1600-0528.1987.tb00478.x. [DOI] [PubMed] [Google Scholar]
  18. Brown L. J., Oliver R. C., Loe H. Evaluating periodontal status of US employed adults. J Am Dent Assoc. 1990 Aug;121(2):226–232. doi: 10.14219/jada.archive.1990.0252. [DOI] [PubMed] [Google Scholar]
  19. Brägger U., Nyman S., Lang N. P., von Wyttenbach T., Salvi G., Schürch E., Jr The significance of alveolar bone in periodontal disease. A long-term observation in patients with cleft lip, alveolus and palate. J Clin Periodontol. 1990 Jul;17(6):379–384. doi: 10.1111/j.1600-051x.1990.tb00034.x. [DOI] [PubMed] [Google Scholar]
  20. Burmeister J. A., Best A. M., Palcanis K. G., Caine F. A., Ranney R. R. Localized juvenile periodontitis and generalized severe periodontitis: clinical findings. J Clin Periodontol. 1984 Mar;11(3):181–192. doi: 10.1111/j.1600-051x.1984.tb01322.x. [DOI] [PubMed] [Google Scholar]
  21. Burt B. A., Ismail A. I., Morrison E. C., Beltran E. D. Risk factors for tooth loss over a 28-year period. J Dent Res. 1990 May;69(5):1126–1130. doi: 10.1177/00220345900690050201. [DOI] [PubMed] [Google Scholar]
  22. Carlos J. P., Wolfe M. D., Zambon J. J., Kingman A. Periodontal disease in adolescents: some clinical and microbiologic correlates of attachment loss. J Dent Res. 1988 Dec;67(12):1510–1514. doi: 10.1177/00220345880670121301. [DOI] [PubMed] [Google Scholar]
  23. Caton J., Greenstein G., Polson A. M. Depth of periodontal probe penetration related to clinical and histologic signs of gingival inflammation. J Periodontol. 1981 Oct;52(10):626–629. doi: 10.1902/jop.1981.52.10.626. [DOI] [PubMed] [Google Scholar]
  24. Caton J., Polson A., Bouwsma O., Blieden T., Frantz B., Espeland M. Associations between bleeding and visual signs of interdental gingival inflammation. J Periodontol. 1988 Nov;59(11):722–727. doi: 10.1902/jop.1988.59.11.722. [DOI] [PubMed] [Google Scholar]
  25. Chasens A. I. Controversies in occlusion. Dent Clin North Am. 1990 Jan;34(1):111–123. [PubMed] [Google Scholar]
  26. Cianciola L. J., Park B. H., Bruck E., Mosovich L., Genco R. J. Prevalence of periodontal disease in insulin-dependent diabetes mellitus (juvenile diabetes). J Am Dent Assoc. 1982 May;104(5):653–660. doi: 10.14219/jada.archive.1982.0240. [DOI] [PubMed] [Google Scholar]
  27. DePaola L. G., Overholser C. D., Meiller T. F., Minah G. E., Niehaus C. Chemotherapeutic inhibition of supragingival dental plaque and gingivitis development. J Clin Periodontol. 1989 May;16(5):311–315. doi: 10.1111/j.1600-051x.1989.tb01661.x. [DOI] [PubMed] [Google Scholar]
  28. Donley T. G., Donley K. B. Systemic bacteremia following toothbrushing: a protocol for the management of patients susceptible to infective endocarditis. Gen Dent. 1988 Nov-Dec;36(6):482–484. [PubMed] [Google Scholar]
  29. Ernster V. L., Grady D. G., Greene J. C., Walsh M., Robertson P., Daniels T. E., Benowitz N., Siegel D., Gerbert B., Hauck W. W. Smokeless tobacco use and health effects among baseball players. JAMA. 1990 Jul 11;264(2):218–224. [PubMed] [Google Scholar]
  30. Finkelstein P., Grossman E. The effectiveness of dental floss in reducing gingival inflammation. J Dent Res. 1979 Mar;58(3):1034–1039. doi: 10.1177/00220345790580030101. [DOI] [PubMed] [Google Scholar]
  31. Garnick J. J., Keagle J. G., Searle J. R., King G. E., Thompson W. O. Gingival resistance to probing forces. II. The effect of inflammation and pressure on probe displacement in beagle dog gingivitis. J Periodontol. 1989 Sep;60(9):498–505. doi: 10.1902/jop.1989.60.9.498. [DOI] [PubMed] [Google Scholar]
  32. Gillett I. R., Johnson N. W., Curtis M. A., Griffiths G. S., Sterne J. A., Carman R. J., Bampton J. L., Wilton J. M. The role of histopathology in the diagnosis and prognosis of periodontal diseases. J Clin Periodontol. 1990 Nov;17(10):673–684. doi: 10.1111/j.1600-051x.1990.tb01053.x. [DOI] [PubMed] [Google Scholar]
  33. Glavind L., Zeuner E. The effectiveness of a rotary electric toothbrush on oral cleanliness in adults. J Clin Periodontol. 1986 Feb;13(2):135–138. doi: 10.1111/j.1600-051x.1986.tb01446.x. [DOI] [PubMed] [Google Scholar]
  34. Gordon J. M., Lamster I. B., Seiger M. C. Efficacy of Listerine antiseptic in inhibiting the development of plaque and gingivitis. J Clin Periodontol. 1985 Sep;12(8):697–704. doi: 10.1111/j.1600-051x.1985.tb00941.x. [DOI] [PubMed] [Google Scholar]
  35. Graves R. C., Disney J. A., Stamm J. W. Comparative effectiveness of flossing and brushing in reducing interproximal bleeding. J Periodontol. 1989 May;60(5):243–247. doi: 10.1902/jop.1989.60.5.243. [DOI] [PubMed] [Google Scholar]
  36. Greenstein G., Caton J., Polson A. M. Histologic characteristics associated with bleeding after probing and visual signs of inflammation. J Periodontol. 1981 Aug;52(8):420–425. doi: 10.1902/jop.1981.52.8.420. [DOI] [PubMed] [Google Scholar]
  37. Grossman E., Meckel A. H., Isaacs R. L., Ferretti G. A., Sturzenberger O. P., Bollmer B. W., Moore D. J., Lijana R. C., Manhart M. D. A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanguinarine on dental plaque and gingivitis. J Periodontol. 1989 Aug;60(8):435–440. doi: 10.1902/jop.1989.60.8.435. [DOI] [PubMed] [Google Scholar]
  38. Haffajee A. D., Socransky S. S., Ebersole J. L., Smith D. J. Clinical, microbiological and immunological features associated with the treatment of active periodontosis lesions. J Clin Periodontol. 1984 Oct;11(9):600–618. doi: 10.1111/j.1600-051x.1984.tb00913.x. [DOI] [PubMed] [Google Scholar]
  39. Haffajee A. D., Socransky S. S., Goodson J. M. Clinical parameters as predictors of destructive periodontal disease activity. J Clin Periodontol. 1983 May;10(3):257–265. doi: 10.1111/j.1600-051x.1983.tb01274.x. [DOI] [PubMed] [Google Scholar]
  40. Hart T. C., Marazita M. L., Schenkein H. A., Brooks C. N., Gunsolley J. G., Diehl S. R. No female preponderance in juvenile periodontitis after correction for ascertainment bias. J Periodontol. 1991 Dec;62(12):745–749. doi: 10.1902/jop.1991.62.12.745. [DOI] [PubMed] [Google Scholar]
  41. Helm S., Petersen P. E. Causal relation between malocclusion and periodontal health. Acta Odontol Scand. 1989 Aug;47(4):223–228. doi: 10.3109/00016358909007705. [DOI] [PubMed] [Google Scholar]
  42. Honkala E., Nyyssönen V., Knuuttila M., Markkanen H. Effectiveness of children's habitual toothbrushing. J Clin Periodontol. 1986 Jan;13(1):81–85. doi: 10.1111/j.1600-051x.1986.tb01418.x. [DOI] [PubMed] [Google Scholar]
  43. Ismail A. I., Burt B. A., Eklund S. A. Epidemiologic patterns of smoking and periodontal disease in the United States. J Am Dent Assoc. 1983 May;106(5):617–621. doi: 10.14219/jada.archive.1983.0137. [DOI] [PubMed] [Google Scholar]
  44. Ismail A. I., Eklund S. A., Burt B. A., Calderone J. J. Prevalence of deep periodontal pockets in New Mexico adults aged 27 to 74 years. J Public Health Dent. 1986 Fall;46(4):199–206. doi: 10.1111/j.1752-7325.1986.tb03142.x. [DOI] [PubMed] [Google Scholar]
  45. Ismail A. I., Morrison E. C., Burt B. A., Caffesse R. G., Kavanagh M. T. Natural history of periodontal disease in adults: findings from the Tecumseh Periodontal Disease Study, 1959-87. J Dent Res. 1990 Feb;69(2):430–435. doi: 10.1177/00220345900690020201. [DOI] [PubMed] [Google Scholar]
  46. Jeffcoat M. K., Jeffcoat R. L., Jens S. C., Captain K. A new periodontal probe with automated cemento-enamel junction detection. J Clin Periodontol. 1986 Apr;13(4):276–280. doi: 10.1111/j.1600-051x.1986.tb02222.x. [DOI] [PubMed] [Google Scholar]
  47. Jeffcoat M. K., Reddy M. S. Progression of probing attachment loss in adult periodontitis. J Periodontol. 1991 Mar;62(3):185–189. doi: 10.1902/jop.1991.62.3.185. [DOI] [PubMed] [Google Scholar]
  48. Jolkovsky D. L., Waki M. Y., Newman M. G., Otomo-Corgel J., Madison M., Flemmig T. F., Nachnani S., Nowzari H. Clinical and microbiological effects of subgingival and gingival marginal irrigation with chlorhexidine gluconate. J Periodontol. 1990 Nov;61(11):663–669. doi: 10.1902/jop.1990.61.11.663. [DOI] [PubMed] [Google Scholar]
  49. Kaslick R. S., Chasens A. I. Periodontosis with periodontitis: a study involving young adult males. II. Clinical, medical, and histopathologic studies. Oral Surg Oral Med Oral Pathol. 1968 Mar;25(3):327–350. doi: 10.1016/0030-4220(68)90007-8. [DOI] [PubMed] [Google Scholar]
  50. Katz P. P., Wirthlin M. R., Jr, Szpunar S. M., Selby J. V., Sepe S. J., Showstack J. A. Epidemiology and prevention of periodontal disease in individuals with diabetes. Diabetes Care. 1991 May;14(5):375–385. doi: 10.2337/diacare.14.5.375. [DOI] [PubMed] [Google Scholar]
  51. LOE H., THEILADE E., JENSEN S. B. EXPERIMENTAL GINGIVITIS IN MAN. J Periodontol. 1965 May-Jun;36:177–187. doi: 10.1902/jop.1965.36.3.177. [DOI] [PubMed] [Google Scholar]
  52. Lang N. P., Adler R., Joss A., Nyman S. Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol. 1990 Nov;17(10):714–721. doi: 10.1111/j.1600-051x.1990.tb01059.x. [DOI] [PubMed] [Google Scholar]
  53. Lang N. P., Cumming B. R., Löe H. Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol. 1973 Jul;44(7):396–405. doi: 10.1902/jop.1973.44.7.396. [DOI] [PubMed] [Google Scholar]
  54. Lang N. P., Hill R. W. Radiographs in periodontics. J Clin Periodontol. 1977 Feb;4(1):16–28. doi: 10.1111/j.1600-051x.1977.tb01879.x. [DOI] [PubMed] [Google Scholar]
  55. Lang N. P., Joss A., Orsanic T., Gusberti F. A., Siegrist B. E. Bleeding on probing. A predictor for the progression of periodontal disease? J Clin Periodontol. 1986 Jul;13(6):590–596. doi: 10.1111/j.1600-051x.1986.tb00852.x. [DOI] [PubMed] [Google Scholar]
  56. Lightner L. M., O'Leary J. T., Drake R. B., Crump P. P., Allen M. F. Preventive periodontic treatment procedures: results over 46 months. J Periodontol. 1971 Sep;42(9):555–561. doi: 10.1902/jop.1971.42.9.555. [DOI] [PubMed] [Google Scholar]
  57. Lindhe J., Koch G. The effect of supervised oral hygiene on the gingivae of children. J Periodontal Res. 1967;2(3):215–220. doi: 10.1111/j.1600-0765.1967.tb01892.x. [DOI] [PubMed] [Google Scholar]
  58. Listgarten M. A., Schifter C. C., Laster L. 3-year longitudinal study of the periodontal status of an adult population with gingivitis. J Clin Periodontol. 1985 Mar;12(3):225–238. doi: 10.1111/j.1600-051x.1985.tb00920.x. [DOI] [PubMed] [Google Scholar]
  59. Listgarten M. A., Slots J., Nowotny A. H., Oler J., Rosenberg J., Gregor B., Sullivan P. Incidence of periodontitis recurrence in treated patients with and without cultivable Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis: a prospective study. J Periodontol. 1991 Jun;62(6):377–386. doi: 10.1902/jop.1991.62.6.377. [DOI] [PubMed] [Google Scholar]
  60. Lobene R. R. A study to compare the effects of two dentifrices on adult dental calculus formation. J Clin Dent. 1989 Winter;1(3):67–69. [PubMed] [Google Scholar]
  61. Locker D., Leake J. L., Hamilton M., Hicks T., Lee J., Main P. A. The oral health status of older adults in four Ontario communities. J Can Dent Assoc. 1991 Sep;57(9):727–732. [PubMed] [Google Scholar]
  62. Löe H., Anerud A., Boysen H., Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J Clin Periodontol. 1986 May;13(5):431–445. doi: 10.1111/j.1600-051x.1986.tb01487.x. [DOI] [PubMed] [Google Scholar]
  63. Löe H., Anerud A., Boysen H., Smith M. The natural history of periodontal disease in man. The rate of periodontal destruction before 40 years of age. J Periodontol. 1978 Dec;49(12):607–620. doi: 10.1902/jop.1978.49.12.607. [DOI] [PubMed] [Google Scholar]
  64. Mandel I. D., Gaffar A. Calculus revisited. A review. J Clin Periodontol. 1986 Apr;13(4):249–257. doi: 10.1111/j.1600-051x.1986.tb02219.x. [DOI] [PubMed] [Google Scholar]
  65. Markkanen H., Rajala M., Paunio K. Periodontal treatment need of the Finnish population aged 30 years and over. Community Dent Oral Epidemiol. 1983 Feb;11(1):25–32. doi: 10.1111/j.1600-0528.1983.tb01350.x. [DOI] [PubMed] [Google Scholar]
  66. McCulloch C. A., Birek P., Hardy V. Comparison of gingival attachment level measurements with an automated periodontal probe and a pressure-sensitive probe. J Periodontal Res. 1987 Sep;22(5):348–352. doi: 10.1111/j.1600-0765.1987.tb01597.x. [DOI] [PubMed] [Google Scholar]
  67. McFarlane C. G., Reynolds J. J., Meikle M. C. The release of interleukin-1 beta, tumor necrosis factor-alpha and interferon-gamma by cultured peripheral blood mononuclear cells from patients with periodontitis. J Periodontal Res. 1990 Jul;25(4):207–214. doi: 10.1111/j.1600-0765.1990.tb00906.x. [DOI] [PubMed] [Google Scholar]
  68. Milgrom P., Weinstein P., Melnick S., Beach B., Spadafora A. Oral hygiene instruction and health risk assessment in dental practice. J Public Health Dent. 1989 Winter;49(1):24–31. doi: 10.1111/j.1752-7325.1989.tb02016.x. [DOI] [PubMed] [Google Scholar]
  69. Miyazaki H., Hanada N., Andoh M. I., Yamashita Y., Saito T., Sogame A., Goto K., Shirahama R., Takehara T. Periodontal disease prevalence in different age groups in Japan as assessed according to the CPITN. Community Dent Oral Epidemiol. 1989 Apr;17(2):71–74. doi: 10.1111/j.1600-0528.1989.tb00591.x. [DOI] [PubMed] [Google Scholar]
  70. Miyazaki H., Pilot T., Leclercq M. H., Barmes D. E. Profiles of periodontal conditions in adults measured by CPITN. Int Dent J. 1991 Apr;41(2):74–80. [PubMed] [Google Scholar]
  71. Nelson R. G., Shlossman M., Budding L. M., Pettitt D. J., Saad M. F., Genco R. J., Knowler W. C. Periodontal disease and NIDDM in Pima Indians. Diabetes Care. 1990 Aug;13(8):836–840. doi: 10.2337/diacare.13.8.836. [DOI] [PubMed] [Google Scholar]
  72. Newman H. N. Plaque and chronic inflammatory periodontal disease. A question of ecology. J Clin Periodontol. 1990 Sep;17(8):533–541. [PubMed] [Google Scholar]
  73. Nishimura F., Nagai A., Kurimoto K., Isoshima O., Takashiba S., Kobayashi M., Akutsu I., Kurihara H., Nomura Y., Murayama Y. A family study of a mother and daughter with increased susceptibility to early-onset periodontitis: microbiological, immunological, host defensive, and genetic analyses. J Periodontol. 1990 Dec;61(12):755–762. doi: 10.1902/jop.1990.61.12.755. [DOI] [PubMed] [Google Scholar]
  74. Novak M. J., Polson A. M., Adair S. M. Tetracycline therapy in patients with early juvenile periodontitis. J Periodontol. 1988 Jun;59(6):366–372. doi: 10.1902/jop.1988.59.6.366. [DOI] [PubMed] [Google Scholar]
  75. Nyman S., Rosling B., Lindhe J. Effect of professional tooth cleaning on healing after periodontal surgery. J Clin Periodontol. 1975 Apr;2(2):80–86. doi: 10.1111/j.1600-051x.1975.tb01728.x. [DOI] [PubMed] [Google Scholar]
  76. Odusanya S. A. Tooth loss among Nigerians: causes and pattern of mortality. Int J Oral Maxillofac Surg. 1987 Apr;16(2):184–189. doi: 10.1016/s0901-5027(87)80128-5. [DOI] [PubMed] [Google Scholar]
  77. Oliver R. C., Brown L. J., Löe H. An estimate of periodontal treatment needs in the U.S. based on epidemiologic data. J Periodontol. 1989 Jul;60(7):371–380. doi: 10.1902/jop.1989.60.7.371. [DOI] [PubMed] [Google Scholar]
  78. Osborn J., Stoltenberg J., Huso B., Aeppli D., Pihlstrom B. Comparison of measurement variability using a standard and constant force periodontal probe. J Periodontol. 1990 Aug;61(8):497–503. doi: 10.1902/jop.1990.61.8.497. [DOI] [PubMed] [Google Scholar]
  79. Overholser C. D., Jr Longitudinal clinical studies with antimicrobial mouthrinses. J Clin Periodontol. 1988 Sep;15(8):517–519. doi: 10.1111/j.1600-051x.1988.tb01024.x. [DOI] [PubMed] [Google Scholar]
  81. Papapanou P. N., Wennström J. L., Gröndahl K. A 10-year retrospective study of periodontal disease progression. J Clin Periodontol. 1989 Aug;16(7):403–411. doi: 10.1111/j.1600-051x.1989.tb01668.x. [DOI] [PubMed] [Google Scholar]
  82. Papli R., Lewis J. M. Refractory chronic periodontitis: effect of oral tetracycline hydrochloride and root planning. Aust Dent J. 1989 Feb;34(1):60–68. doi: 10.1111/j.1834-7819.1989.tb03007.x. [DOI] [PubMed] [Google Scholar]
  83. Perry D. A., Newman M. G. Occurrence of periodontitis in an urban adolescent population. J Periodontol. 1990 Mar;61(3):185–188. doi: 10.1902/jop.1990.61.3.185. [DOI] [PubMed] [Google Scholar]
  84. Ramfjord S. P. Maintenance care for treated periodontitis patients. J Clin Periodontol. 1987 Sep;14(8):433–437. doi: 10.1111/j.1600-051x.1987.tb02247.x. [DOI] [PubMed] [Google Scholar]
  85. Ranney R. R. Diagnosis of periodontal diseases. Adv Dent Res. 1991 Dec;5:21–36. doi: 10.1177/08959374910050010201. [DOI] [PubMed] [Google Scholar]
  86. Reddy J., Parker J. R., Africa C. W., Stephen L. X. Prevalence and severity of periodontitis in a high fluoride area in South Africa. Community Dent Oral Epidemiol. 1985 Apr;13(2):108–112. doi: 10.1111/j.1600-0528.1985.tb01688.x. [DOI] [PubMed] [Google Scholar]
  87. Rich S. K., Friedman J. A., Schultz L. A. Effects of flossing on plaque and gingivitis in third grade schoolchildren. J Public Health Dent. 1989 Spring;49(2):73–77. doi: 10.1111/j.1752-7325.1989.tb02029.x. [DOI] [PubMed] [Google Scholar]
  88. Rivera-Hidalgo F. Smoking and periodontal disease. A review of the literature. J Periodontol. 1986 Oct;57(10):617–624. doi: 10.1902/jop.1986.57.10.617. [DOI] [PubMed] [Google Scholar]
  89. Robertson P. B., Walsh M., Greene J., Ernster V., Grady D., Hauck W. Periodontal effects associated with the use of smokeless tobacco. J Periodontol. 1990 Jul;61(7):438–443. doi: 10.1902/jop.1990.61.7.438. [DOI] [PubMed] [Google Scholar]
  90. Rosling B., Nyman S., Lindhe J. The effect of systematic plaque control on bone regeneration in infrabony pockets. J Clin Periodontol. 1976 Feb;3(1):38–53. doi: 10.1111/j.1600-051x.1976.tb01849.x. [DOI] [PubMed] [Google Scholar]
  91. Rugg-Gunn A. J. A double-blind clinical trial of an anticalculus toothpaste containing pyrophosphate and sodium monofluorophosphate. Br Dent J. 1988 Aug 20;165(4):133–136. doi: 10.1038/sj.bdj.4806519. [DOI] [PubMed] [Google Scholar]
  92. Savitt E. D., Socransky S. S. Distribution of certain subgingival microbial species in selected periodontal conditions. J Periodontal Res. 1984 Mar;19(2):111–123. doi: 10.1111/j.1600-0765.1984.tb00800.x. [DOI] [PubMed] [Google Scholar]
  93. Saxén L. Heredity of juvenile periodontitis. J Clin Periodontol. 1980 Aug;7(4):276–288. doi: 10.1111/j.1600-051x.1980.tb01970.x. [DOI] [PubMed] [Google Scholar]
  94. Schmid M. O., Balmelli O. P., Saxer U. P. Plaque-removing effect of a toothbrush, dental floss, and a toothpick. J Clin Periodontol. 1976 Aug;3(3):157–165. doi: 10.1111/j.1600-051x.1976.tb01863.x. [DOI] [PubMed] [Google Scholar]
  95. Schürch E., Jr, Minder C. E., Lang N. P., Geering A. H. Periodontal conditions in a randomly selected population in Switzerland. Community Dent Oral Epidemiol. 1988 Jun;16(3):181–186. doi: 10.1111/j.1600-0528.1988.tb00570.x. [DOI] [PubMed] [Google Scholar]
  96. Shoha R. R., Dowson J., Richards A. G. Radiographic interpretation of experimentally produced bony lesions. Oral Surg Oral Med Oral Pathol. 1974 Aug;38(2):294–303. doi: 10.1016/0030-4220(74)90071-1. [DOI] [PubMed] [Google Scholar]
  97. Socransky S. S., Haffajee A. D., Goodson J. M., Lindhe J. New concepts of destructive periodontal disease. J Clin Periodontol. 1984 Jan;11(1):21–32. doi: 10.1111/j.1600-051x.1984.tb01305.x. [DOI] [PubMed] [Google Scholar]
  98. Suomi J. D., Greene J. C., Vermillion J. R., Doyle J., Chang J. J., Leatherwood E. C. The effect of controlled oral hygiene procedures on the progression of periddontal disease in adults: results after third and final year. J Periodontol. 1971 Mar;42(3):152–160. doi: 10.1902/jop.1971.42.3.152. [DOI] [PubMed] [Google Scholar]
  99. Suomi J. D., Peterson J. K., Matthews B. L., Voglesong R. H., Lyman B. A. Effects of supervised daily dental plaque removal by children after 3 years. Community Dent Oral Epidemiol. 1980 Aug;8(4):171–176. doi: 10.1111/j.1600-0528.1980.tb01281.x. [DOI] [PubMed] [Google Scholar]
  100. Suomi J. D., Smith L. W., Chang J. J., Barbano J. P. Study of the effect of different prophylaxis frequencies on the periodontium of young adult males. J Periodontol. 1973 Jul;44(7):406–410. doi: 10.1902/jop.1973.44.7.406. [DOI] [PubMed] [Google Scholar]
  101. Vehkalahti M. Occurrence of gingival recession in adults. J Periodontol. 1989 Nov;60(11):599–603. doi: 10.1902/jop.1989.60.11.599. [DOI] [PubMed] [Google Scholar]
  102. Walsh M., Heckman B., Leggott P., Armitage G., Robertson P. B. Comparison of manual and power toothbrushing, with and without adjunctive oral irrigation, for controlling plaque and gingivitis. J Clin Periodontol. 1989 Aug;16(7):419–427. doi: 10.1111/j.1600-051x.1989.tb01670.x. [DOI] [PubMed] [Google Scholar]
  103. Weinstein P., Milgrom P., Melnick S., Beach B., Spadafora A. How effective is oral hygiene instruction? Results after 6 and 24 weeks. J Public Health Dent. 1989 Winter;49(1):32–38. doi: 10.1111/j.1752-7325.1989.tb02017.x. [DOI] [PubMed] [Google Scholar]
  104. Wennström J. L., Papapanou P. N., Gröndahl K. A model for decision making regarding periodontal treatment needs. J Clin Periodontol. 1990 Apr;17(4):217–222. doi: 10.1111/j.1600-051x.1990.tb00016.x. [DOI] [PubMed] [Google Scholar]
  105. Wilcoxon D. B., Ackerman R. J., Jr, Killoy W. J., Love J. W., Sakumura J. S., Tira D. E. The effectiveness of a counterrotational-action power toothbrush on plaque control in orthodontic patients. Am J Orthod Dentofacial Orthop. 1991 Jan;99(1):7–14. doi: 10.1016/S0889-5406(05)81674-9. [DOI] [PubMed] [Google Scholar]
  106. Wilton J. M., Johnson N. W., Curtis M. A., Gillett I. R., Carman R. J., Bampton J. L., Griffiths G. S., Sterne J. A. Specific antibody responses to subgingival plaque bacteria as aids to the diagnosis and prognosis of destructive periodontitis. J Clin Periodontol. 1991 Jan;18(1):1–15. doi: 10.1111/j.1600-051x.1991.tb01112.x. [DOI] [PubMed] [Google Scholar]
  107. Zacherl W. A., Pfeiffer H. J., Swancar J. R. The effect of soluble pyrophosphates on dental calculus in adults. J Am Dent Assoc. 1985 May;110(5):737–738. doi: 10.14219/jada.archive.1985.0441. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES