Successful management for periodontal disease

Restoration and Implantology
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Noted dentist Tim Bradstock-Smith calls for a better understanding of periodontal disease

Patients can sometimes have a negative attitude towards periodontal treatment. They can perceive the procedures as unpleasant or unnecessary [1] and even after some discussion, it is common for patients to neglect periodontal treatment plans. However, as dental professionals know, periodontitis is a major cause of tooth loss and can impact significantly on speech, nutrition, self-esteem and quality of life [2]. Periodontal patients need to fully understand the nature of the condition – that it is a dysbiotic inflammatory disease and could increase the risks of cardiovascular disease, diabetes, aspirational pneumonia and some cancers, among other systemic diseases [3].

For many patients, implementing an improved oral health care regime can be enough to kerb further development of the disease. However, others may require professional mechanical cleaning and maintenance therapy. While scaling and root planning remains the ‘gold standard’ of non-surgical periodontal treatment [4], it has been suggested that this should be restricted to intermediate and deep pockets, as shallow sites might lose attachment following treatment [5]. Nevertheless, even clinically successful treatment has a high probability of pocket reinfection and, the presence of deep pockets promotes the accumulation of a higher concentration of periodontal pathogens, which is an important risk factor for further disease progression [5].

Research also indicates that in patients with periodontitis, pathogens are not just restricted to deep periodontal pockets, but may also be present at high levels and proportions in supragingival biofilm, as well as in ‘healthy’ sites and on oral surfaces [4].4 Consequently, evidence is growing in support of medicinal and pharmacologic strategies as part of periodontal treatment [4,6],4, yet, more comprehensive trials are required to establish safety, effectiveness, optimal dosage and timing of such therapies. Similarly, as technology evolves and the appeal of achieving periodontal health in the least invasive and most cost-efficient manner possible, there has also been renewed interest in conservative surgical techniques.

It is apparent that finding the most favourable treatment pathway for periodontal patients can be a challenge. Nevertheless, each case should be assessed individually and a multi-disciplinary, team approach can help to keep them motivated and increase the chances of success. With a precise and consistent protocol to ensure that the treatment is achieved, and that the patient has access to an effective network of support, most patients can be treated successfully within the practice.

However, the value of working with a referral centre like the London Smile Clinic should never be underestimated. Some practitioners believe that contacting a periodontal specialist should be reserved for complex, challenging or unresponsive cases, yet a Specialist Periodontist such as Dr. Hatem Algraffee can also support general practitioners with defining simple and complex cases, offering advice and helping to plan and manage periodontal treatment from beginning to end. As a leading professional in the field of periodontics, Dr. Algraffee is available to take on chronic, challenging and aggressive cases while keeping the referring practitioner informed throughout all procedures. The London Smile Clinic is a centre of dental excellence and only carries out treatment that is requested by referring dentists. Patients receive a five-star service and are always safely returned for any on going maintenance therapy or dental care.

Studies show that good compliance with supportive periodontal care can achieve high levels of tooth retention in periodontal patients [7]. By explaining the condition thoroughly, promoting improved oral health and providing an efficient protocol for management, dental professionals can heighten the success rate of all periodontal treatment pathways.

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1] Sharpe G, et al. Attitudes regarding specialist referrals in periodontics. British Dental Journal 202, E11 - E11 (2007) Published online: 16 February 2007 | doi:10.1038/bdj.2007.141. [Accessed 21st February 2018]
2] Chapple, I.L.C, et al. (2015). Primary prevention of periodontitis: managing gingivitis. Journal of Clinical Periodontology, 42, 71-76. [Accessed 21st February 2018]
3] Hajishengallis G. (2015). Periodontitis: from microbial immune subversion to systemic inflammation. Nature Reviews Immunology, 15 (1), 30-44. [Accessed 21st February 2018]
4] Cobb CM. (2008) Microbes, inflammation, scaling and root planning and the periodontal condition. J Dent Hyg. 2008 Oct; 82 Suppl 3:4-9.  [Accessed 21st February 2018]
5] Feres, M., et al. (2015). Systemic antibiotics in the treatment of periodontitis. Periodontology 2000, 67, 131-186
6] Golub, L. M., et al. (2016). Non-antibacterial tetracycline formulations: host-modulators in the treatment of periodontitis and relevant systemic diseases. International Dental Journal.
7] Galindo R. et al. (2015) Periodontal re-treatment in patients on maintenance following pocket reduction surgery. OHDM Feb 14 (1) 58-63. [Accessed 21st February 2018]