Risk factors
It has been recognized that the progression of periodontal disease, its severity, and its response to treatment varies from patient to patient. Bacteria are important for disease but insufficient by themselves to cause the disease. It is the patient’s risk factors, and the host susceptibility that determine probability to the disease. Risk factors are patient characteristics associated with the development of disease. There are a number of acquired and environmental risk factors that can increase a patient’s susceptibility and play a major role in the host response to disease. The risk factors that should be assessed because they can affect the rate of progression, onset , and response to therapy and severity of periodontal disease.
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Microbe-to-microbe attachment, structural heterogeneity, complex community interactions and genetic diversity. Dental plaque is a microbial biofilm. As with any biofilm, the constituent microbes are firmly adherent to each other and to an oral substrate by means of an extracellular matrix, i.e, slime layer or glycocalix, into which they are embeded3, 14. The microbial populations in biofilm have 2 ways that facilitate them to effectively survive within their community. The first is a high rate of reproduction for continued survival, and the second is physiologic adaptation to the available environmental resources or life-supporting capacity of the environment. 15 Biofilms intrinsically dictate profound changes in the behavior of individual microbes. Their relationship to the host, and their response to environmental conditions. 16 Indeed, oral biofilms, as diverse entities, are the contributing agents of biological processes such as dental caries, periimplantitis, and periodontal disease. Rather than any single microbe evading the host defense and causing disease.17 Biofilms demonstrate characteristics that influence the clinical managing of inflammatory periodontal disease. For example, both altered patterns of microbial gene expression and the mass and composition of the extracellular matrix reduce the vulnerability of microbes to antimicrobial agents.18, 19, 20 Bacteria growing in dental biofilms exhibit an improved acceptance to antimicrobial agents, including those used in mouthrinses and dentifrices.21-24 In addition, confocal microscopy of in situ established natural biofilms showed that chlorhexidine only affected the external layers. Cells in 24 and 48 hours plaque biofilms, suggesting either quenching of the agent at the biofilm surface or a lack of infiltration.25 More over, biofilms of oral bacteria are also more