Perio health

04 January 2010
Volume 26 · Issue 1

Amit Patel attended a ‘first class’ seminar on periodontology.

Curved interdental brush facilitate interdental plaque removal.

 

In late October I attended a Proctor & Gamble lecture on periodontology held at the Hilton Metropole near the NEC in Birmingham. The hotel was a good venue for the evening, the hosts were hospitable and the food was hearty. There was a very good turn out; a mixture of dentists, hygienists, nurses and receptionists.The first lecturer to present was Prof Peter Heasman from Newcastle University. He covered the topic of gingival recession with a very apt title in view of the current economic climate Emerging from recession without the need for ‘cuts’. Prof Heasman discussed the aetiological factors that may cause gingival recession and he emphasized that it is no single cause but a multifactorial one.He explained that there are relatively few cohort studies and almost no longitudinal studies to show natural historical data linking toothbrushing as a single causative factor with gingival recession. There has also been a suggestion that gingival recession tends to be associated with a high standard of plaque control as well as a low standard of plaque control. The high standard groups tended to have buccal lesions and, unsurprisingly, the low standard groups with chronic inflammatory diseases tend to have lingual lesions. He said there is very little concrete evidence to associate toothbrushing with recession as there are many variables involved, such as how often people brushed their teeth, brushing duration, bristle size, bristle hardness and type of toothpaste used.One important aetiological factor that was touched on was patient induced trauma either due to habits or an underlying psychiatric condition. He demonstrated this with a very interesting case he treated over a period of years, where the patient was suffering from Munchausen Syndrome.  Prof Heasman concluded that when treating gingival recession defects it is essential to identify the aetiology and to control this before intervening surgically if need be. He also emphasized the importance of reassuring the patient that the tooth will not be lost as long there is a high standard of oral hygiene.

After a short coffee break Prof Val Clerehugh from Leeds University took to the stage and presented the topicof Maintaining periodontal health - what matters?Prof Clerehugh initially discussed the referral policy as set by the British Society of Periodontology and the importance of screening all our patients for periodontal disease using a BPE probe. This is critical for your patients’ oral health and also for your peace of mind since medico-legal complaints are increasing due to undiagnosed periodontal disease and failure to adequately treat or refer the patient to a specialist. Previously it was thought that periodontal disease was based on an infection model but over the years there has been a paradigm shift to an inflammation model.  Prof Clerehugh explained eloquently how periodontal disease is based on a balance, that is, the host response to the bacterial challenge present, and how a shift in the delicate balance can change from a state of health to disease.One of the most debated topics in periodontal disease is whether the inflammatory process of the disease has an effect on the rest of the body.  Prof Clerehugh mentioned that the editors of the American Journal of Cardiology and the Journal of Periodontology have met to try and agree a consensus on the link between periodontal disease and cardiovascular disease. They concluded that, at present, periodontitis may increase the risk of CVD, but as yet the evidence is based on small cohort studies and case reports.Prof Clerehugh also emphasized the importance of Supportive Periodontal Therapy once the periodontal disease has been stabilized. The main goal of SPT is to reduce the incidence of tooth loss by actively monitoring the periodontal tissues and teeth. Reinforcing oral hygiene instructions at each visit is also essential as is the need to perform subgingival plaque removal of any periodontal pockets. Prof Clerehugh described a study by a hygienist, Maggie Jackson, who obtained her MPhil from Leeds University. Maggie designed a curved interdental brush (Vision interdental brushes) which helped to depress the interdental tissues apically, thereby facilitating interdental plaque removal. The study showed that significantly less plaque and probing depths were noted compared to flossing alone. Prof Clerehugh emphasised that evidence suggests SPT should take the form of three to six monthly visits but each patient should have their own SPT regime based on their potential risk.The evening was excellent. The topics covered were informative and up-to-date and stimulated discussion from the audience both during and after the meeting.  Credit should be given to P&G for hosting a first class meeting and not using the occasion to push their own products, but simply support the CPD requirements of the profession.

Patient risk factors:

  • Smoking
  • Bleeding on probing >25%
  • Residual pockets of 5mm or more (8 sites or more)
  • 8 teeth or more lost
  • Increased loss of attachment in younger patients
  • Systemic factors (eg diabetes)