Effect of Non-surgical Periodontal Therapy on Interleukin-34 Level in Gingival Crevicular Fluid in Patients With Periodontal Disease (Controlled Clinical Trial)

Periodontal disease is a chronic disease of various inflammatory diseases where the early symptoms are gingival redness, swelling, and bleeding. As the disease progresses, periodontal pockets, clinical attachment loss (CAL) as well as alveolar bone resorption may occur. If left untreated, periodontal disease can lead to loss of teeth which directly affects patient's mastication.

A new system of periodontal classification has been adopted, in which the types of disease that were previously identified as "chronic" or "aggressive" Armitage, 1999 are now classified under one category ("periodontitis") and re-diagnosed on the basis of many variants (staging and grading system).

The stage is based on the severity of the disease and the complexity of the disease management (in terms of loss of clinical attachment between teeth (CAL), radiographic bone loss, and tooth loss), complexity, and size and distribution. Grading provides additional information about the biological features of the disease, including history-based analysis of the progression rate of periodontitis; progression risk assessment; analysis of possible adverse effects of treatment; and risk assessment that the disease or its treatment may adversely affect the patient's normal life.

Periodontitis is described in four stages ranging from Stage I: Initial periodontitis (CAL 1-2mm), Stage II: Moderate periodontitis (CAL 3-4 mm), Stage III: Severe periodontitis with potential for additional tooth loss (<4), and(CAL≥5mm) Stage IV: Severe periodontitis with potential for loss of dentition (≥5) and (CAL≥5mm). Grading focuses on assessing risk factors like smoking, diabetes, and outcomes of scaling and root debridement. Grade A: Slow rate of progression (no CAL loss over 5 years), Grade B: Moderate rate of progression (CAL loss<2mm over 5years), and Grade C: Rapid rate of progression (CAL loss ≥2 mm over 5 years).

Periodontitis occurs due to a complex of genetic, environmental, and bacterial interaction in which bacterial and host factors play an important role. The imbalance between the previous two factors results in a completely different change from health state to inflammatory disease and once inflammation has begun, activation of many cytokines and molecular mechanisms occur.