President’s note

 

Dear Colleagues,

 

The 20th anniversary volume of Analecta Periodontologica signals significant changes to the official publication of the Hellenic Society of Periodontology and possibly to the Greek dental literature. Starting with this volume, Analecta Periodontologica is published in both Greek and English languages and will from now on be published in this bilingual format. The printed version of the journal is accompanied by an online counterpart posted at the official website of the Hellenic Society of Periodontology at the following address: www.periodontology.gr. Free access to the online version of the journal is provided by the Hellenic Society of Periodontology. These recent innovations represent an opening to the international scientific milieu, and at the same time, an opportunity for international critique. We expect that the Hellenic Society of Periodontology and the Greek periodontal community, both here in Greece and abroad, will respond successfully to the challenge.

Analecta Periodontologica acquired a monograph format in the last few years and each issue is focused on a specific theme related to the art and science of periodontology. This year, the journal is devoted to “periodontal medicine”, a topic with certain aspects that actually transcend the limits of our specialty. For many years, the disciplines of medicine and dentistry have traditionally been on parallel trajectories. However, within this general framework, signs of significant convergence are lately obvious, based on the emerging indications linking diseases of the oral cavity, and particularly periodontal diseases, to systemic health. The decisive factor in this development has been the spectacular progress in understanding the pathogenetic mechanisms of periodontal inflammation. The most recent scientific evidence tends to confirm that inflammation is the missing link between a number of seemingly different pathological conditions.

Periodontal disease is a bacterial infection, which, as it develops, induces a series of destructive changes around the teeth, including loss of connective tissue, absorption of alveolar bone, formation of periodontal pockets and, if the disease remains untreated, loosening and loss of teeth. The progression of periodontal disease is based on one hand on the direct action ofperiopathogenic bacteria and their highly toxic by-products and on the other hand on the immune response of the host. The microbial action is evidently not confined to the neighboring tissues: through blood circulation, bacteria and their by-products trigger the release of cytokines, such as interleukin-6 and tumor necrosis factor-α, which in turn activate the acute phase response and the whole process acquires a systemic nature.

As in most fields of scientific inquiry, the association between periodontal diseases and systemic disorders is not directly or equally evident in all cases. The strongest correlation is reported in numerous studies between periodontal disease and diabetes mellitus. Diabetes is a significant risk factor for periodontal disease, and untreated periodontitis worsens glycemic control of the diabetic patient. A characteristic underscore of the observed association is the fact that periodontitis is often referred to as the “sixth diabetes complication”. Another correlation that in recent years has aroused strong interest among researchers and clinicians is the link between periodontal inflammation and cardiovascular diseases. Many studies have reported that certain periopathogenic bacteria contribute to the development of atherosclerosis, resulting in cardiovascular diseases. Epidemiological and clinical trials have also linked periodontal disease to adverse pregnancy outcomes, pointing out that pregnant women with periodontitis are seven times more likely to deliver preterm, low-birth-weight babies. Moreover, periodontitis has also been correlated to osteoporosis, certain respiratory disorders, and rheumatoid arthritis, a pathological condition with many similarities in the mechanisms of tissue destruction.

The available data are not so far sufficient to establish the same strong correlations for all pathological conditions and considerable effort still needs to be made to reach reliable conclusions. However, treatment of oral diseases, and particularly treatment of periodontal diseases, is in itself a means of maintaining oral health and the well-being of the whole body. Therefore, the elimination of inflammation from the oral cavity should comprise a primary and fundamental objective in our therapeutic approach. If to all the above we also consider the ever-growing evidence of the probable effects of periodontal disease on general health, we should realize that the maintenance of oral health is an urgent necessity and not just the means for preserving an attractive smile, as is naively believed by many people. The dentist undertakes a significant proportion of the responsibility for the patient’s general health, and the dental curricula should be adapted to effectively prepare the future professional for the management of the periodontal medicine patient. On the other hand, patients should be informed about the relationship between periodontitis and inflammatory conditions and the probable additional benefits of periodontal treatment on systemic health.

Undoubtedly, much still remains to be clarified on the association between oral and systemic health.Periodontal medicine will challenge the traditional patient approach and may actually alter the way we practice periodontology. Currently established treatment techniques may or may not be efficient to control the systemic inflammatory burden and to prevent the risk for the development of systemic diseases. Therapeutic guidelines should be proposed to treat oral infection so as to shield systemic health in high-risk individuals. Realistic treatment outcomes following periodontal medicine therapy must be established. Periodontitis may soon be considered in medical physical examinations and periodontal therapy may turn into a medical requirement.

We believe that in 20th issue of Analecta Periodontologica you will find contemporary viewpoints on periodontal medicine, formulated by distinguished colleagues. We thank all the invited authors for their invaluable participation and for supporting the Hellenic Society of Periodontology. In addition, this is our first opportunity to express our sincere appreciation to all members of the review board who patiently undertake the vital task of reviewing the manuscripts submitted to the journal. Finally, we thank the new Editor-in-Chief of Analecta Periodontologica, for taking on the responsibility of the first bilingual edition and for his overall efforts to bring the official publication of the Hellenic Society of Periodontology into today’s highly competitive, international, rapidly changing scientific publishing environment.

 

George Baltas

President of the Hellenic Society of Periodontology