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Contemporary Management of Periodontal Diseases

Dr. Ian Needleman, President-elect 2017 of the British Society of Periodontology; Specialist in Periodontics; Professor and Honorary Consultant in the UCL Eastman Dental Institute, spoke with Dr. Suham Alexander about how periodontal health impacts a person’s life. Dr. Needleman was recently a speaker at the 2016 British Dental Association’s Conference in Manchester, UK.

Highlights

In this video, Dr. Ian Needleman, shares with us some of the highlights from his recent presentation, “Contemporary Management of Periodontal Diseases”, at the British Dental Association conference from May 2016.

Most importantly, a patient-centred approach to periodontitis is essential in developing a relationship with the patient and to understand his/her perspective of what it is like to live with a diagnosis of periodontitis and the ensuing treatment.

Periodontics is changing and developing which impacts our management of periodontal diseases. Research has shown that periodontal treatment can improve the quality of patients’ lives which is a message that clinicians should be delivered to our patients.

There are some causes of periodontitis that we can address in a very straight-forward manner.

  1. Gingivitis

Data shows that individuals who have long-standing gingivitis are more likely to develop periodontitis. Those that have bleeding or consistent gingivitis at a single site on a tooth are more than 40 times more likely to lose this tooth.

  1. Tobacco and smoking cessation

Smoking and tobacco use impact periodontal health as well as the treatment rendered. Safety data on e-cigarettes and vaping is not clear and less well-studied. However, the use of e-cigarettes/vaping is 95% safer than smoking and may be an alternative for patients that currently smoke.

  1. Diabetes

It is important to understand that diabetics generally have cycles of good and poor glycemic control over a long period of time. Diabetic patients should be managed, therefore, as though they are at high risk of periodontal disease.

  1. Plaque control

Behaviour change techniques can be useful as they are brief, structured and remove “emotion” from plaque control. They allow a progressive approach for patients to follow and lets the patient have “wins” along the way to build upon.

Non-surgical therapy, control of risk factors and a maintenance program can go a long way in treating periodontal disease. However, there are times when these techniques may not work as well and surgical intervention may be required in a few sites. Surgery is indicated in sites where non-surgical treatment has not helped but, the tooth is not compromised or hopeless. Additionally, regenerative surgery is useful in changing tooth prognosis as long as cases are selected carefully.

When considering placing implants in patients who have been treated or have periodontal disease, one must realize that these patients are at a higher risk of developing peri-implantitis. Research shows that 20% of patients that have been treated for periodontitis successfully will develop peri-implantitis. This presents a challenging situation as all peri-implantitis treatments have a degree of unpredictability.

Clinicians must really use a patient-centric treatment approach when treating periodontal disease. The patient must take ownership and realize that much of the treatment lies in his/her control for reducing or eliminating risk factors. The clinician can work in partnership with the patient to help guide and eliminate factors in small but, committed steps to optimize their oral health.

Periodontology is now embarking upon exciting times. Humans are 10% mammalian and 90% bacterial in nature. This may guide the future of how periodontists and periodontology manage the disease and change the microbiome that exists in our bodies to achieve a healthier body.

 

Additional Resources

  1. Scottish Dental Clinical Effectiveness Program
  2. Oral Hygiene TIPPS (Talk, Instruct, Practice, Plan, Support) Video
  3. British Society of Periodontology resource page on the web
  4. The Sound of Periodontitis
  5. #howsyoursmile

 

 

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