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Raittio E, Lopez R, Baelum V. Contesting the conventional wisdom of periodontal risk assessment. Community Dent Oral Epidemiol 2024. [PMID: 38243665 DOI: 10.1111/cdoe.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
Over the years, several reviews of periodontal risk assessment tools have been published. However, major misunderstandings still prevail in repeated attempts to use these tools for prognostic risk prediction. Here we review the principles of risk prediction and discuss the value and the challenges of using prediction models in periodontology. Most periodontal risk prediction models have not been properly developed according to guidance given for the risk prediction model development. This shortcoming has led to several problems, including the creation of arbitrary risk scores. These scores are often labelled as 'high risk' without explicit boundaries or thresholds for the underlying continuous risk estimates of patient-important outcomes. Moreover, it is apparent that prediction models are often misinterpreted as causal models by clinicians and researchers although they cannot be used as such. Additional challenges like the critical assessment of transportability and applicability of these prediction models, as well as their impact on clinical practice and patient outcomes, are not considered in the literature. Nevertheless, these instruments are promoted with claims regarding their ability to deliver more individualized and precise periodontitis treatment and prevention, purportedly resulting in improved patient outcomes. However, people with or without periodontitis deserve proper information about their risk of developing patient-important outcomes such as tooth loss or pain. The primary objective of disseminating such information should not be to emphasize assumed treatment efficacy, hype individualization of care, or promote business interests. Instead, the focus should be on providing individuals with locally validated and regularly updated predictions of specific risks based on readily accessible and valid key predictors (e.g. age and smoking).
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Affiliation(s)
- Eero Raittio
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Rodrigo Lopez
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vibeke Baelum
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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2
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Kornman KS. Contemporary approaches for identifying individual risk for periodontitis. Periodontol 2000 2019; 78:12-29. [PMID: 30198138 DOI: 10.1111/prd.12234] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Key breakthroughs in our understanding of the etiology and principles of predictable treatment of patients with chronic periodontitis first emerged in the late 1960s and carried on into the mid-1980s. Unfortunately, some generalizations of the evidence led many to believe that periodontitis was a predictable result of exposure to bacterial plaque accumulations over time. For a brief period, the initial plaque concept was translated by some to implicate specific bacterial infections, with both concepts (plaque exposure and specific infection) being false assumptions that led to clinical outcomes which were frustrating to both the clinician and the patient. The primary misconceptions were that every individual was equally susceptible to periodontitis, that disease severity was a simple function of magnitude of bacterial exposure over time, and that all patients would respond predictably if treated based on the key principles of bacterial reduction and regular maintenance care. We now know that although bacteria are an essential initiating factor, the clinical severity of periodontitis is a complex multifactorial host response to the microbial challenge. The complexity comes from the permutations of different factors that may interact to alter a single individual's host response to challenge, inflammation resolution and repair, and overall outcome to therapy. Fortunately, although there are many permutations that may influence host response and repair, the pathophysiology of chronic periodontitis is generally limited to mild periodontitis with isolated moderate disease in most individuals. However, approximately 20%-25% of individuals will develop generalized severe periodontitis and probably require more intensive bacterial reduction and different approaches to host modulation of the inflammatory outcomes. This latter group may also have serious systemic implications of their periodontitis. The time appears to be appropriate to use what we know and currently understand to change our approach to clinical care. Our goal would be to increase our likelihood of identifying those patients who have a more biologically disruptive response combined with a more impactful microbial dysbiosis. Current evidence, albeit limited, indicates that for those individuals we should prevent and treat more intensively. This paper discusses what we know and how we might use that information to start individualizing risk and treat some of our patients in a more targeted manner. In my opinion, we are further along than many realize, but we have a great lack of prospective clinical evidence that must be accumulated while we continue to unravel the contributions of specific mechanisms.
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Affiliation(s)
- Kenneth S Kornman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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3
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Ryder MI, Couch ET, Chaffee BW. Personalized periodontal treatment for the tobacco- and alcohol-using patient. Periodontol 2000 2018; 78:30-46. [PMID: 30198132 PMCID: PMC6132065 DOI: 10.1111/prd.12229] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The use of various forms of tobacco is one of the most important preventable risk factors for the incidence and progression of periodontal disease. Tobacco use negatively affects treatment outcomes for both periodontal diseases and conditions, and for dental implants. Tobacco-cessation programs can mitigate these adverse dental treatment outcomes and may be the most effective component of a personalized periodontal treatment approach. In addition, heavy alcohol consumption may exacerbate the adverse effects of tobacco use. In this review, the microbiology, host/inflammatory responses and genetic characteristics of the tobacco-using patient are presented as a framework to aid the practitioner in developing personalized treatment strategies for these patients. These personalized approaches can be used for patients who use a variety of tobacco products, including cigarettes, cigars, pipes, smokeless tobacco products, e-cigarettes and other tobacco forms, as well as patients who consume large amounts of alcohol. In addition, principles for developing personalized tobacco-cessation programs, using both traditional and newer motivational and pharmacological approaches, are presented.
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Affiliation(s)
- Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Elizabeth T Couch
- Department or Preventive and Restorative Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Benjamin W Chaffee
- Department or Preventive and Restorative Sciences, School of Dentistry, University of California, San Francisco, CA, USA
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Meisel P, Holtfreter B, Völzke H, Kocher T. Self-reported oral health predicts tooth loss after five and ten years in a population-based study. J Clin Periodontol 2018; 45:1164-1172. [DOI: 10.1111/jcpe.12997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/29/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Peter Meisel
- Dental School; University of Greifswald; Greifswald Germany
- Dental Clinics; Department of Periodontology; University Medicine Greifswald; Greifswald Germany
| | - Birte Holtfreter
- Dental School; University of Greifswald; Greifswald Germany
- Dental Clinics; Department of Periodontology; University Medicine Greifswald; Greifswald Germany
| | - Henry Völzke
- Institute for Community Medicine; Ernst Moritz Arndt University Greifswald; Greifswald Germany
| | - Thomas Kocher
- Dental School; University of Greifswald; Greifswald Germany
- Dental Clinics; Department of Periodontology; University Medicine Greifswald; Greifswald Germany
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5
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Lü D, Meng H, Xu L, Wang X, Zhang L, Tian Y. Root abnormalities and nonsurgical management of generalized aggressive periodontitis. J Oral Sci 2017; 59:103-110. [PMID: 28367890 DOI: 10.2334/josnusd.16-0258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
To investigate long-term nonsurgical treatment outcomes in patients with generalized aggressive periodontitis (GAgP) and the impact of root abnormalities (RAs) and other patient-level factors in relation to GAgP progression. Patients (n = 64) from a GAgP cohort who completed active nonsurgical periodontal treatment and consented to re-evaluation after 3 to 11 (mean 5.3) years, were enrolled. RAs were identified using radiographs. Periodontal parameters (e.g., probing depths [PDs], and tooth loss [TL]) were investigated. Multivariate analysis was performed to identify factors contributing to TL and bone level alteration (∆BL). After treatment, the mean number of sites with PDs > 5 mm decreased from 54.3 to 17.2. Annual TL was 0.11/patient. Twenty-one patients (32.8%) had >4 teeth with root abnormalities (RA-teeth) and exhibited a higher risk for TL (univariate odds ration [OR] = 3.52, multivariate logistic OR = 6.57). Factors correlated to ∆BL were sites with residual PD > 5 mm (β = -0.400) and observation time (β = -0.210). Nonsurgical treatment provides beneficial outcomes in GAgP patients. Higher incidence of RAs and high prevalence of residual deep pockets have a negative impact on long-term outcomes. PRACTICAL IMPLICATIONS in cases of GAgP with residual deep pockets and high incidence of RAs, clinicians must emphasize that long-term outcomes of nonsurgical treatment may be compromised.
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Affiliation(s)
- Da Lü
- Department of Periodontology, Peking University School and Hospital of Stomatology
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6
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Asimakopoulou K, Rhodes G, Daly B. Risk communication in the dental practice. Br Dent J 2017; 220:77-80. [PMID: 26794113 DOI: 10.1038/sj.bdj.2016.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/09/2022]
Abstract
The communication of risk in dental settings is a routine task that most clinicians are familiar with in their clinical encounters. However, work from medical settings has suggested that using this process in order to support health behaviour change in people may well be undermined by difficulties in understanding risk information, in presenting the information in a way that is clearly understood by the recipient and in the effects that such information may have for supporting further health behaviours by patients. This paper synthesises literature in the area that addresses these issues and explores approaches dental care professionals might consider when communicating risks in the dental surgery.
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Affiliation(s)
- K Asimakopoulou
- King's College London, Dental Institute, Division of Population and Patient Health, Social and Behavioural Sciences Group, Floor 18, Guy's Tower, Great Maze Pond, London, SE1 9RW
| | - G Rhodes
- King's College London, Dental Institute, Division of Population and Patient Health, Social and Behavioural Sciences Group, Floor 18, Guy's Tower, Great Maze Pond, London, SE1 9RW
| | - B Daly
- King's College London, Dental Institute, Division of Population and Patient Health, Social and Behavioural Sciences Group, Floor 18, Guy's Tower, Great Maze Pond, London, SE1 9RW
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Taschieri S, Del Fabbro M, Francetti L, Perondi I, Corbella S. Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures? J Endod 2016; 42:1191-5. [PMID: 27291502 DOI: 10.1016/j.joen.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/06/2016] [Accepted: 05/10/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim of the present controlled clinical trial was to compare 2 incision techniques, papilla base incision (PBI) and sulcular incision (IS), evaluating changes in papilla and recession height over a 12-month period. METHODS A total of 24 subjects requiring endodontic surgery on a single tooth were enrolled. PBI was used in 1 group and IS in the other group. The primary outcomes were changes in gingival recession of the tooth affected by periapical lesions and the mesial and distal teeth and the mesial and distal papilla height using the treated tooth as the reference. Outcome variables were assessed at baseline and 12 months after the surgical intervention. Statistical analysis was performed by a blinded operator through appropriate tests, with significance set at a P value equal to .05. RESULTS In the PBI group, the papilla height at the 12-month follow-up in the mesial and distal aspect decreased 0.10 ± 0.32 mm and 0.10 ± 0.32 mm, respectively, and 0.23 ± 0.68 mm and 0.25 ± 0.40 mm, respectively, in the IS group without any significant differences. There were no differences found for recession change values between groups. CONCLUSIONS The PBI and IS approaches in endodontic surgery showed similar results in terms of papilla height preservation and recession changes.
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Affiliation(s)
- Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Isabella Perondi
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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Testori T, Clauser C, Deflorian M, Capelli M, Zuffetti F, Fabbro MD. A Retrospective Analysis of the Effectiveness of the Longevity Protocol for Assessing the Risk of Implant Failure. Clin Implant Dent Relat Res 2016; 18:1113-1118. [DOI: 10.1111/cid.12428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/29/2016] [Accepted: 04/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Tiziano Testori
- Visiting professor, Head of the Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Sciences, Dental Clinic (Chairman: Prof. R.L. Weinstein), IRCCS Galeazzi Institute, University of Milan; Milan Italy
| | - Carlo Clauser
- private practice in Florence, President of the Accademia Toscana di Ricerca Odontostomatologica
| | - Matteo Deflorian
- Section of Implant Dentistry and Oral Rehabilitation (Head: Prof. T. Testori), Department of Biomedical, Surgical and Dental Sciences, Dental Clinic (Chairman: Prof. R.L. Weinstein), IRCCS Galeazzi Institute, University of Milan; Milan Italy
| | - Matteo Capelli
- Section of Implant Dentistry and Oral Rehabilitation (Head: Prof. T. Testori), Department of Biomedical, Surgical and Dental Sciences, Dental Clinic (Chairman: Prof. R.L. Weinstein), IRCCS Galeazzi Institute, University of Milan; Milan Italy
| | - Francesco Zuffetti
- Section of Implant Dentistry and Oral Rehabilitation (Head: Prof. T. Testori), Department of Biomedical, Surgical and Dental Sciences, Dental Clinic (Chairman: Prof. R.L. Weinstein), IRCCS Galeazzi Institute, University of Milan; Milan Italy
| | - Massimo Del Fabbro
- associate professor, Head of Section of Oral Physiology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Institute, University of Milan; Milan Italy
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9
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Garcia RI, Compton R, Dietrich T. Risk assessment and periodontal prevention in primary care. Periodontol 2000 2016; 71:10-21. [DOI: 10.1111/prd.12124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
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10
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Hur Y, Choi SK, Ogata Y, Stark PC, Levi PA. Microbiologic Findings in Relation to Risk Assessment for Periodontal Disease: A Cross-Sectional Study. J Periodontol 2016; 87:21-6. [DOI: 10.1902/jop.2015.140237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Asimakopoulou K, Newton JT, Daly B, Kutzer Y, Ide M. The effects of providing periodontal disease risk information on psychological outcomes - a randomized controlled trial. J Clin Periodontol 2015; 42:350-5. [DOI: 10.1111/jcpe.12377] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Koula Asimakopoulou
- Dental Institute at Guy's; King's College and St Thomas' Hospitals; Division of Population and Patient Health; London UK
| | - Jonathon Tim Newton
- Dental Institute at Guy's; King's College and St Thomas' Hospitals; Division of Population and Patient Health; London UK
| | - Blánaid Daly
- Dental Institute at Guy's; King's College and St Thomas' Hospitals; Division of Population and Patient Health; London UK
| | - Yvonne Kutzer
- Dental Institute at Guy's; King's College and St Thomas' Hospitals; Division of Population and Patient Health; London UK
| | - Mark Ide
- Dental Institute at Guy's; King's College and St Thomas' Hospitals; Division of Mucosal and Salivary Biology; London UK
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Dhulipalla R, Bade S, Bollepalli AC, Katuri KK, Devulapalli NS, Swarna C. Evaluation of Periodontal Risk in Adult Patients using Two Different Risk Assessment Models - A Pilot Study. J Clin Diagn Res 2015; 9:ZC25-9. [PMID: 25859520 PMCID: PMC4378802 DOI: 10.7860/jcdr/2015/11772.5556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/29/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the periodontal risk of individuals using periodontal risk assessment (PRA) model and modified PRA model. MATERIALS AND METHODS A total of 50 patients with chronic periodontitis, age 30-60 years were selected randomly and charting of the periodontal status was performed and those who met the inclusion criteria were enrolled in the study. Parameters recorded were- percentage of sites with bleeding on probing (BOP), number of sites with pocket depths (PD) ≥ 5mm, number of the teeth lost, bone loss (BL)/age ratio, Clinical attachment loss(CAL)/age ratio, diabetic and smoking status, dental status, systemic factors like diabetes were assessed. All the risk factors were plotted on the radar chart in (PRA) and (mPRA) models, using Microsoft excel and periodontal risk were categorized as low, moderate and high risk. RESULTS Among 50 patients 31 were in low risk, 9 in moderate risk, and 10 in high risk identified by modified (PRA) model, whereas 28 patients were in low risk, 13 in moderate risk and 9 in high risk identified by (PRA). Statistical analysis demonstrated that there was no significant difference between the risk scores (X(2) = 0.932 with degree of freedom = 2, P = 0.627). CONCLUSION Both the periodontal risk models are effective in evaluating the risk factors and can be useful tool for predicting proper diagnosis, disease progression and therapeutic strategies during the supportive periodontal therapy.
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Affiliation(s)
- Ravindranath Dhulipalla
- Professor, Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Shruthi Bade
- PG Student, Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Appaiah Chowdary Bollepalli
- Senior Lecturer, Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Kishore Kumar Katuri
- Reader, Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Narasimha Swamy Devulapalli
- Head of Department, Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Chakrapani Swarna
- Professor, Department of Periodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
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Armitage GC. Learned and unlearned concepts in periodontal diagnostics: a 50-year perspective. Periodontol 2000 2014; 62:20-36. [PMID: 23574462 DOI: 10.1111/prd.12006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the past 50 years, conceptual changes in the field of periodontal diagnostics have paralleled those associated with a better scientific understanding of the full spectrum of processes that affect periodontal health and disease. Fifty years ago, concepts regarding the diagnosis of periodontal diseases followed the classical pathology paradigm. It was believed that the two basic forms of destructive periodontal disease were chronic inflammatory periodontitis and 'periodontosis'- a degenerative condition. In the subsequent 25 years it was shown that periodontosis was an infection. By 1987, major new concepts regarding the diagnosis and pathogenesis of periodontitis included: (i) all cases of untreated gingivitis do not inevitably progress to periodontitis; (ii) progression of untreated periodontitis is often episodic; (iii) some sites with untreated periodontitis do not progress; (iv) a rather small population of specific bacteria ('periodontal pathogens') appear to be the main etiologic agents of chronic inflammatory periodontitis; and (v) tissue damage in periodontitis is primarily caused by inflammatory and immunologic host responses to infecting agents. The concepts that were in place by 1987 are still largely intact in 2012. However, in the decades to come, it is likely that new information on the human microbiome will change our current concepts concerning the prevention, diagnosis and treatment of periodontal diseases.
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Abstract
Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.
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Koshi E, Rajesh S, Koshi P, Arunima PR. Risk assessment for periodontal disease. J Indian Soc Periodontol 2013; 16:324-8. [PMID: 23162323 PMCID: PMC3498698 DOI: 10.4103/0972-124x.100905] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/12/2011] [Indexed: 11/25/2022] Open
Abstract
The prevention and treatment of periodontal disease is based on accurate diagnosis, reduction or elimination of causative agents, risk management and correction of the harmful effects of the disease. The practice of risk assessment involves dental care providers identifying patients and populations at increased risk of developing periodontal disease. This can have a significant impact on clinical decision making. Risk assessment reduces the need for complex periodontal therapy, improve patient outcome and, ultimately, reduce oral health care cost. The awareness of risk factors also helps with the identification and treatment of co-morbidities in the general population as many periodontal disease risk factors are common to other chronic diseases such as diabetes, cardiovascular diseases and stroke.
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Affiliation(s)
- Elizabeth Koshi
- Department of Periodontics, Sree Mookambika Institute of Dental Sciences, Kulashekharam, Kanyakumari, Tamil Nadu, India
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Garton BJ, Ford PJ. Root caries and diabetes: risk assessing to improve oral and systemic health outcomes. Aust Dent J 2012; 57:114-22. [PMID: 22624749 DOI: 10.1111/j.1834-7819.2012.01690.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report reviews the current understanding of the relationship between diabetes and root caries, and investigates the evidence for dental chairside testing of gingival crevicular blood (GCB) glucose levels to assess risk for type 2 diabetes mellitus. Diabetes is linked with the progression of periodontal disease and a greater number of exposed root surfaces at risk for root caries. The rapidly increasing prevalence of type 2 diabetes coupled with a general trend towards retention of teeth means that the number of patients with increased risk for root caries is expanding significantly. Many patients with diabetes or abnormal blood glucose levels are unaware of their condition or that they are at increased risk for oral disease. Systemic blood glucose concentrations are comparable to those found in GCB and therefore may be a useful adjunctive clinical aid in determining appropriate care for patients and providing timely referrals to general medical practitioners. Use of GCB testing within the dental clinic is described. It is proposed that future studies be undertaken to provide clinicians with improved risk assessment strategies and to evaluate GCB glucose screening models.
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Affiliation(s)
- B J Garton
- School of Dentistry, The University of Queensland, Brisbane
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Kye W, Davidson R, Martin J, Engebretson S. Current Status of Periodontal Risk Assessment. J Evid Based Dent Pract 2012; 12:2-11. [DOI: 10.1016/s1532-3382(12)70002-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Shanbhag S, Dahiya M, Croucher R. The impact of periodontal therapy on oral health-related quality of life in adults: a systematic review. J Clin Periodontol 2012; 39:725-35. [DOI: 10.1111/j.1600-051x.2012.01910.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Siddharth Shanbhag
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London; UK
| | - Manu Dahiya
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London; UK
| | - Ray Croucher
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London; UK
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20
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Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology. J Periodontol 2011; 82:943-9. [DOI: 10.1902/jop.2011.117001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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21
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Leininger M, Tenenbaum H, Davideau JL. Modified periodontal risk assessment score: long-term predictive value of treatment outcomes. A retrospective study. J Clin Periodontol 2010; 37:427-35. [PMID: 20507367 DOI: 10.1111/j.1600-051x.2010.01553.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the long-term clinical predictive value of the periodontal risk assessment diagram surface (PRAS) score and the influence of patient compliance on the treatment outcomes. MATERIALS AND METHODS Thirty subjects suffering from periodontitis were re-examined 6-12 years after the initial diagnosis and periodontal treatments. The baseline PRAS score was calculated from the initial clinical and radiograph records. Patients were then classified into a low-to-moderate (0-20) or a high-risk group (>20). Patients who did not attend any supportive periodontal therapy were classified into a non-compliant group. PRAS and compliance were correlated to the mean tooth loss (TL)/year and the mean variation in the number of periodontal pockets with a probing depth (PPD) >4 mm. RESULTS TL was 0.11 for the low-to-moderate-risk group and 0.26 for the high-risk group (p<0.05); PPD number reduction was 2.57 and 2.17, respectively, and bleeding on probing reduction was 6.7% and 23.3%, respectively. Comparing the compliance groups, the PPD number reduction was 3.39 in the compliant group and 1.40 in the non-compliant group (p<0.05). CONCLUSION This study showed the reliability of PRAS in evaluating long-term TL and patient susceptibility to periodontal disease. Our data confirmed the positive influence of patient compliance on periodontal treatment outcomes.
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Affiliation(s)
- Matthieu Leininger
- Department of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
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Ryder MI. Concepts, controversies, consensus, and conclusions: preface. Periodontol 2000 2009; 50:9-12. [PMID: 19388949 DOI: 10.1111/j.1600-0757.2009.00299.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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