Principles and concepts of treatment derived from these studies, and their application to dentistry. 12th James A. English lecture series

Non-surgical approach to advanced chronic periodontitis: a 17.5-year case report

This 17.5-year longitudinal case report details the treatment of advanced chronic periodontitis in a female patient commencing at 34 years of age. The woman was provided with periodontal care comprising of temporary fixation, scaling and root planing, intra-pocket irrigation using a root canal syringe and regular supervised maintenance. The patient presented with a 10-year history of bleeding gums. Therapy conducted in general practice had included simple curettage and irrigation. However, these treatments proved unsuccessful and the patient often changed dentists seeking better treatment. She presented to the University Dental Hospital, for diagnosis and treatment of her periodontal conditions after her mandibular lateral incisor had exfoliated. On presentation a purulent exudate could be expressed from all of the pockets. All anterior teeth, excluding the maxillary canines, demonstrated +2 to +3 mobility. The patient did not want any surgical treatment or her teeth extracted. It was decided to treat the patient conservatively without surgery. By postponing extraction, the authors were in a better position to determine the prognosis of the remaining teeth after the infection was under control. Although six teeth were extracted during the 17.5 years, this case report suggests that a non-surgical approach is a viable option while maintaining regular visits for periodontal care.

Awareness of periodontal diseases: the professional and the civil servant

Newly qualified dentists and dental hygienists should have a good level of awareness of periodontal diseases. However, for a variety of reasons this knowledge may not be regularly updated or applied in practice. This paper considers how professional awareness can be influenced by such factors as: maintaining an up to date understanding of the nature of periodontal diseases, the routine use of appropriate screening and examination techniques, factors influencing assessment of treatment need, patient records, continuing professional education and an understanding of patient expectations. It goes on to describe how civil servants may help to stimulate improvements in awareness levels to periodontal diseases by promoting continuing education, epidemiological research and national oral health strategies as well as through legislation and regulation. The paper concludes that although a range of organisations can promote improvements in professional awareness, unless simultaneous efforts are made to improve the awareness of the general public to periodontal diseases, it is difficult to see how there can be an improvement in the periodontal health of the population.