This is now the third issue of Dental Clinics of North America I have edited on the subject of periodontology. The first, published in 2005, attempted to provide a broad summary of the state-of-the-art and science of periodontics for the general practitioner as it existed at that moment and included articles on etiology, epidemiology, diagnosis and risk assessment, prevention, systemic impact, and treatment. For the second issue, I thought a focus on the myriad treatment approaches taken to manage periodontal disease would be of interest. Thus, articles were provided on a range of treatment modalities, from simple nonsurgical mechanical treatment strategies, to the use of lasers, various regenerative approaches, implants, nonsurgical chemotherapeutic strategies, as well as nascent treatment approaches that include developing techniques involving gene therapy, RNA interference, and stem cells. For both issues, each article was written by recognized experts who graciously provided their time and skills that culminated in two fairly comprehensive and up-to-date summaries of the discipline of periodontology.
When asked to again edit this issue of Dental Clinics of North America on periodontics, I struggled to define a theme that would not simply rehash the previous issues. As a member of the American Academy of Periodontology, I am able to monitor their “Open Forum,” an on-line “chat room” that allows members of the Academy to share ideas. Like all chat rooms, the participants are not afraid to offer their opinions on a variety of topics, including the efficacy of various treatment and diagnostic modalities. Over time, it became evident to me that not all practitioners seemed to agree on what strategies work well in the clinical setting. Indeed, what seemed most clear is that we are faced with many unanswered questions regarding the effectiveness of a number of strategies in routine use in clinical practice. Hence, the theme of the present issue, “Unanswered Questions in Periodontology,” was born. I made a rather long list of a number of questions for which I did not have an obvious answer. This list was whittled down, and I searched the literature to identify potential authors who seemed most able to address the questions posed using the latest evidence. Again, in virtually all cases, the authors agreed to contribute, and the issue came together.
In all, 11 questions are posed. I believe all of the questions are provocative and are answered using the latest evidence. It is my hope that the reader will not only be able to use the information provided to help make more definitive and effective treatment decisions for their patients but also become better educated and knowledgeable about the complex nature of periodontal disease.
It has been a pleasure to work with each of the contributors, and I thank them all for making available their time and talents. I also very much appreciate the support of the editorial staff of Dental Clinics of North America. I especially would like to express my gratitude to John Vassallo, who continues to invite me back, and to Kristen Helm, who patiently guided me through the editorial process. Much appreciation to colleagues who generously agreed to provide expert reviews for several articles: Drs. Albert Best, David E. Deas, Jill Bashutski, Peter Polverini, Thomas E. Rams, and Dimitris Tatakis.