Periodontal diagnosis in private dental practice: a case-based survey

Validation of a Simplified Digital Periodontal Health Screening Module for General Dental Practitioners

As a silent disease, individuals at risk of periodontitis are not easily identified until the disease has become severe. Early detection at the community level is essential, especially for general dental practitioners. The aim of this study was to design a comprehensive, user-friendly tool to screen patients’ periodontal health at community level and to evaluate users’ acceptance of its use. The periodontal health screening module was first developed by an expert panel of periodontists, public health specialists and general dentists. The developed module was tested for content acceptance on 156 graduating dental students from three public schools and later validated by 12 private general dental practitioners (GDPs) for reliability. Most of the students (64.1%) found the new module an easy assessment tool for periodontal health compared to the Basic Periodontal Examination (BPE). Most claimed that they understand the contents (80.8%) and accepted the designs (86.6%) and agreed (82.7%) that the new assessment module would allow them to screen patients anytime in the clinic. The interrater reliability as assessed between the GDPs and the investigators revealed acceptable agreement ranging from 62.5–100.0% (mean 89.6 ± 10.2%). The simplified digital periodontal health screening module showed promising acceptance for application in private general dental clinics.

Periodontal Diseases: Major Exacerbators of Pulmonary Diseases?

Periodontal diseases are a range of polymicrobial infectious disorders, such as gingivitis and periodontitis, which affect tooth-supporting tissues and are linked to playing a role in the exacerbation of several pulmonary diseases. Pulmonary diseases, such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, COVID-19, and bronchiectasis, significantly contribute to poor quality of life and mortality. The association between periodontal disease and pulmonary outcomes is an important topic and requires further attention. Numerous resident microorganisms coexist in the oral cavity and lungs. However, changes in the normal microflora due to oral disease, old age, lifestyle habits, or dental intervention may contribute to altered aspiration of oral periodontopathic bacteria into the lungs and changing inflammatory responses. Equally, periodontal diseases are associated with the longitudinal decline in spirometry lung volume. Several studies suggest a possible beneficial effect of periodontal therapy in improving lung function with a decreased frequency of exacerbations and reduced risk of adverse respiratory events and morbidity. Here, we review the current literature outlining the link between the oral cavity and pulmonary outcomes and focus on the microflora of the oral cavity, environmental and genetic factors, and preexisting conditions that can impact oral and pulmonary outcomes.

Cone beam computed tomography (CBCT) in periodontal diseases: a Systematic review based on the efficacy model

Background

Periodontal diseases are prevalent among adult populations. Its diagnosis depends mainly on clinical findings supported by radiographic examinations. In previous decades, cone beam computed tomography has been introduced to the dental field. The aim of this study was to address the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in periodontics based on a systematic search and analysis of the literature using the hierarchical efficacy model.

Methods

A systematic search of electronic databases such as PubMed, Scopus, Web of Science, and Cochrane was conducted in February 2019 to identify studies addressing the efficacy of CBCT imaging in Periodontics. The identified studies were subjected to pre-identified inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for an appraisal of the literature on diagnostic imaging modality. Four examiners performed the eligibility and quality assessment of relevant studies and consensus was reached in cases where disagreement occurred.

Results

The search resulted in 64 studies. Of these, 34 publications were allocated to the relevant level of efficacy and quality assessments wherever applicable. The overall diagnostic accuracy of the included studies showed a low or moderate risk of bias and applicability concerns in the use of CBCT. In addition, CBCT is accurate in identifying periodontal defects when compared to other modalities. The studies on the level of patient outcomes agreed that CBCT is a reliable tool for the assessment of outcomes after the treatment of periodontal defects.

Conclusion

CBCT was found to be beneficial and accurate in cases of infra-bony defects and furcation involvements.

Periodontal treatment in private dental practice: a case-based survey

BACKGROUND

This study aimed to assess the management and referral patterns of Victorian general dental practitioners based on periodontal diagnosis.

METHODS

Following ethics approval, Victorian general dental practitioners were invited to complete five randomized text-based periodontitis scenario questionnaires. Based on their diagnosis, respondents were asked for their management options and asked to specify who would perform these treatments. Respondents were also asked about referral procedures.

RESULTS

One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne. Of the total respondents, 22.5% worked in a practice employing a hygienist. The management of periodontal disease was appropriate, and treatment options increased with severity. As severity increased, patients were more likely to be referred to a periodontist. Periodontal services referred by general dentists to dental hygienists increased with the number of days the hygienists worked within a practice. Over- and underdiagnosis did not markedly affect management. The recommendation of antibiotics, mouthwashes and periodontal surgery varied depending on year and school of graduation.

CONCLUSIONS

The general dentists that completed the survey are managing periodontal conditions appropriately and according to current guidelines.