Screening for periodontal disease

The prime objective of screening is to detect disease at an earlier stage than would normally occur with people presenting with the disease, on the assumption that earlier treatment would alter the natural history of the disease in a significant proportion. However, before a screening survey is done a number of conditions should be fulfilled. The disease should be an important health problem; there should be effective and acceptable treatments available for those with the disease; the natural history of the disease should be adequately understood and there should be an agreed policy on whom to treat. Periodontal disease does not fulfil many of the requirements for a disease suitable for population screening. There is no reliable evidence that earlier detection alters the natural history of the disease or the survival and function of the teeth. Neither is there sufficient information on the importance of clinical signs of periodontal disease. We do not know whether screening tests are able to detect periodontal diesease which is likely to have an important impact on periodontal health. For example, is bleeding an important sign of destructive periodontal disease? Does gingivitis evidenced as redness progress to alveolar bone destruction? The lack of answers to these questions casts serious doubts on the accuracy of estimates of periodontal treatment needs which include all persons with a positive gingivitis score as needing treatment. A number of other gaps in our knowledge relating to periodontal disease are outlined. Because of these, it was concluded that screening for periodontal disease is not justified at present. Instead, research should be directed at answering questions about the natural history of periodontal diseases, the effectiveness of prevention and treatment, the significance of clinical signs of periodontal disease and the validity, sensitivity and specificity of the signs.