A ‘global burden’. How do we treat periodontitis?

Described as a global burden, severe periodontitis has been reported to be the sixth most prevalent medical condition in the world (Kassebaum et al, 2015). In the UK, the disease affects about half of adults, with up to 15% estimated to have the condition severely (www.nhs.uk, 2015).  These shocking statistics echo the findings of the 2009 Adult Dental Health Survey, which reported that, although this generation has a better outlook than their predecessors, there are still many people whose oral health and function does not meet the best possible standards (Health and Social Care Information Centre, 2009). How to we treat periodontitis?

 

Major health implications

Periodontal disease is a particular area of concern because it can cause serious oral health problems when left untreated, and can result in tooth loss as well as deterioration of both gingiva and bone. Ominously, the potential effects and implications of the disease may also extend beyond oral health. Research has established that periodontal infection is a probable risk factor for various systemic diseases, including pulmonary disease (Scannapieco et al, 1998).

Furthermore, periodontal disease has the capability of changing the chemical composition of the blood and glucose levels, as well as interfering with the body’s inflammatory system and thereby increasing Practitioners should continue to advise patients of the overall benefits of maintaining good oral health, says Tim Bradstock-Smith the risk of diabetes, rheumatoid arthritis (www. perio.org, 2015) and respiratory (Sharma et al, 2011) and cardiovascular diseases (Machado et al, 2005; Genco et al, 2001).

As we know, tobacco use, stress and obesity may be significant risk factors in the development and progression of periodontal disease. However, people with other general health conditions also have an increased risk of developing the condition. Evidence has consistently revealed that diabetes is a risk factor for the prevalence of gingivitis and periodontitis (Mealey and Oates, 2006) and a five-year follow-up population-based study in Taiwan (Chang et al, 2014) also indicated that patients with osteoporosis might have an increased chance of developing periodontitis.

Over the last few decades the concept of a genetic vulnerability to periodontal disease has also been investigated (Schafer et al, 2011). Since the completion of the Human Genome Project, researchers have found evidence to suggest that a key element of whether individuals develop periodontitis appears to be controlled by the way they interact with environmental agents including biofilm. These researchers also believe that periodontal disease could be categorised more effectively using pathobiology-based grouping, as well as the clinical presentation of the disease, rather than the current clinical only classifications of ‘chronic’ and ‘aggressive’ (Panos et al, 2014).

 

Periodontal therapy

A categorising system based on the molecular profiling of gingival tissues has been devised, which could enable earlier diagnosis and personalised treatment. It is hoped that patients susceptible to severe periodontitis may be considered for assertive therapy, thereby preventing aggressive progression.

Of course treatment for periodontal disease depends upon each individual case, but every patient must appreciate the importance of practicing good oral hygiene. Employing an improved oral healthcare regime may be enough to kerb further development of the disease in some patients, although professional scaling and debridement is commonly required to remove plaque, calculus and biofilm from the teeth and roots. For some patients it is necessary to include ongoing periodontal therapy with medication to keep infection under control and to heal periodontal pockets.

Nevertheless, in aggressive cases it may be necessary to perform flap surgery to clean the area thoroughly and suture periodontal pockets. Some of these patients may also require bone grafting to promote new growth or tissue regeneration to cover any exposed roots.

 

Complex cases

In many cases a general dentist, therapist or hygienist can treat patients with periodontal disease successfully. However, in complex or unresponsive cases, the skills of a specialist periodontist may be needed. By creating a good working relationship with a reliable referral practice, such as London Smile Clinic, your patients can benefit from specialist clinical skills in a wide spectrum of dentistry.

With a wealth of experience in oral and maxillofacial surgery, Dr Hatem Algraffee, specialist periodontist at London Smile Clinic, invites practitioners to refer their perio-patients for treatment. Referring dentists can rest assured that their patients will receive unprecedented clinical treatment in five-star surroundings but also, they will be safely returned for continuing dental care.

Research continues to explore the risks and effects of periodontal disease. However, the findings so far suggest that practitioners should continue to advise patients that they could significantly boost their overall health and reduce the possibility of periodontal disease by maintaining good oral health.

 

Dr Tim Bradstock- Smith is principal of the London Smile Clinic, an award-winning centre of excellence in dentistry that is based in central London. The clinic offers an extensive range of services, which include specialist orthodontics, implant dentistry and dentures.

*This article was originally published in DH&T magazine

 

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