Shifting paradigms in periodontal disease. Implications for prevention in the elderly.

Our understanding of periodontal diseases has evolved considerably. No longer are the notions of universal susceptibility to plaque and calculus with automatic reliance on mechanical debridement valid. The interplay between specific bacteria and the immune response within a complex context of risk factors forms the new paradigm of periodontal disease pathogenesis. New approaches to treatment and prevention and their implications in the elderly will be discussed.