Dietary shifts may explain the incidence of periodontitis in industrialized countries.

A new hypothesis for the etiology of periodontal disease is presented. We suggest that the formation of calcifying dental plaque, together with an established gingival sulcus, leads to circumstances which favor the growth of pathogenic microbes associated with the destruction of the periodontium. We assume that, in ancient humans, this problem was avoided by the nonexistence of sulci around the teeth. Such a situation may have resulted from the usage of a hard and gritty diet which caused occlusal attrition compensated by tooth eruption. Unfortunately, in modern humans, sulcus formation is normal. However, only a part of the population in industrialized countries has hard, calcifying dental plaque any more. Soft plaque may be associated with the lower calcium content of the modern diet. The impetus behind the introduction of this alternative hypothesis now is our fear that routine treatment of this disease by antibiotics will lead into an insoluble dilemma.