Since that time, significant advances have occurred in the understanding of the histopathology, epidemiology, natural history, and effectiveness of prevention and management of multimicrobial infection leading to plaque-associated gingivitis and periodontitis. Burden of Suffering Periodontal diseases are the most prevalent chronic diseases affecting children, adolescents, adults, and the elderly. Gingivitis is a necessary but not sufficient prerequisite for initiation of periodontitis. Loss of alveolar bone results in formation of a pocket around the tooth which then acts as a reservoir favouring the growth of anerobic bacteria. In most people, advanced periodontitis affects relatively few teeth.
Dental plaque is the bacterial mass that adheres to and builds up on a tooth surface.
Calculus or calcified dental plaque acts as a retention web for bacteria. It is associated with loss of attachment in patients with poor oral hygiene status who have limited access to professional dental care but not in those with excellent oral hygiene status. There is no evidence to support any direct causal role for calculus in the initiation of gingivitis or periodontitis but calculus is an important contributor to the chronicity of both. Other risk factors are non-insulin dependent diabetes and possibly malocclusion and defective host defenses. Periodontal pocket depth provides a cross-sectional indicator of periodontitis but does not indicate whether the disease is active or not.