New Concepts in Periodontal Disease

Cosmetic and Perio Treatment
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Dr Paul Renton-Harper: Periodontal disease and diabetes

A growing body of evidence demonstrates a possible link between periodontal disease (PD) and systemic health, which could prove significant for both dentists and allied healthcare professionals in daily practice.

The general public are increasingly aware that such links exist and are concerned about the implications. A 2017 study published in the BMJ suggested that dental practices are ideal locations to screen patients for diabetes, especially as PD might prove to be an early complication of the condition [1].

Specialist periodontist and owner of Renton-Harper Periodontics in Bristol, Dr Paul Renton-Harper believes dental professionals have an important role to play in the wider healthcare setting with regard to the treatment of PD and systemic conditions including diabetes. Paul and his dental team already measure patients’ glycated haemoglobin levels when assessing their PD risk.

He says: “We have identified a significant number of people who are pre-diabetic and, occasionally, those who are probably diabetic, which I consider to be a valuable public health service. Pre-diabetic patients have responded well to the information we provide – get more exercise and improve their diet – which has helped reverse their pre-diabetic condition.

“If dental professionals can identify diabetes at the earliest stage, they can have a positive impact on patients’ overall health. This may involve collaborating and co-ordinating with other healthcare professionals, which should soon be coming to the fore in day-to-day practice.

“For a long time, dentistry in the UK has been considered as separate from the rest of medicine and yet, dentists treat problems inside the mouth – why is this different to treating the soft and hard tissues in other areas of the body?”

Advanced diagnostic and monitoring techniques for periodontal disease will be a key theme for Paul’s lecture in the Next Generation Conference at this year’s British Dental Conference and Dentistry Show, during which he will discuss the aetiology of PD and how emerging concepts may prove useful in the assessment and treatment of these conditions, particularly in more complex cases.

Paul adds: “In the future, dental professionals will be able to look at the microbiology and immunology of PD, as well as environmental effects in terms of deciding how active the disease is in each patient. By doing this, we can look at other ways to effectively target the different mechanisms involved in the development and progression of PD in advanced cases.”

Professional cleaning in practice combined with good oral hygiene at home is sufficient for most patients to improve their periodontal condition. However, if dental professionals have carried out appropriate treatment, but are not seeing the response they expect, this might indicate that the patient is failing to achieve the necessary standard of oral hygiene.

Paul continues: “Some patients are simply more susceptible to PD, so their level of oral hygiene needs to be higher. However, there are a very small number of patients who present with more complex problems and require more advanced care, having not responded to careful, straight-forward and rigorous periodontal treatment.

“We need to look at how we can help these patients, particularly considering the current litigious climate. If practitioners fail to treat such cases – whether in-house or through referrals – and patients start to lose their teeth, then dento-legal problems could arise.”

Paul will also explore a new generation of chemical aids that can support oral hygiene for the most vulnerable, high-risk patients, “Having demonstrated its clinical efficacy through years of research, Perio Plus+ is an innovative product range comprised of mouth rinses, toothpaste and gel that contain natural ingredients.

“Perio Plus+ can be used between the stages of periodontal treatment in order to combat plaque. After all, most would agree that effective plaque control through oral hygiene is the basis of successful periodontal treatment.”

1] Teeuw, W. J., Kosho, M. X. F., Poland, D. C. W., Gerdes, V. E. A. and Loos, B. G. (2017) Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Research and Care. 5: e000326. DOI: 10.1136/bmjdrc-2016-000326.

The British Dental Conference and Dentistry Show, Birmingham NEC, co-located with DTS.

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