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The 20th century brought major advances in dentistry. Fluoridation of the water supply has been identified as one of the top 10 public health initiatives of the 20th century and has resulted in a 30 to 50% reduction in dental caries. Dental implants have changed the rules of the game by offering patients an expanded range of options for replacement. Advances in dentistry have been so dramatic that dentists are now isolating stem cells from dental tissues and manipulating them for tissue reconstruction. However, in spite of these dramatic improvements in general dentistry and several other dental specializations, for decades, the role of periodontists has been somewhat stationary. During that time, the profession has only focused on the treatment and prevention of periodontitis, or placing dental implants. However, periodontists are more than "gum doctors," and there are at least 3 reasons to emphasize the new more central role periodontists will play in 21st century dentistry. First, many diseases and disorders can have important effects on oral health. For instance, periodontitis is more prevalent in patients with poorly controlled diabetes. Linear gingival erythema is a prominent part of the presentation of human immunodeficiency virus infection. Periodontists can detect and prevent the oral diseases associated with these other conditions. Second, the reverse is also true. Periodontal disease has been identified as a risk factor for diseases and disorders at distant sites, including cardiovascular and cerebrovascular disease, diabetes, adverse obstetric outcomes, and respiratory diseases. Theoretically speaking, by treating and preventing gum disease, periodontists can save the lives of patients who could have been at risk for one of these other potentially life-threatening conditions. The third reason is an aging society. The population of many industrialized countries is aging. Thus, periodontists must care for a larger number of older and periodontitis-affected patients who are systemically compromised at the same time. Periodontists should be as familiar with systemic diseases as medical doctors are, and they should use this knowledge for more informed treatment choices and for patient education. The concepts presented here are not new, but we all have been reluctant to recognize them in our zeal to strive for excellence in our core area of knowledge and skill-placing and studying dental implants. The 21st century expects us to do better, and more. Let us now strive as a professional society and as individual clinicians and researchers to embrace the century's challenges and opportunities. Then, our efforts will have positive impacts on public health that extend far beyond our specialized field.
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