A multidisciplinary and holistic approach _ Lorraine Pretty

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  Posted by: Dental Design      15th April 2019

Despite the best efforts of dental professionals, oral health product companies and various charitable and professional organisations, periodontal disease remains rife throughout the UK. It’s crucial that we all continue to do what we can with regards to raising awareness of the condition among the general population, while also providing tried and tested solutions that we can rely on to help patients improve their oral health.

A new classification system 

Announced at EuroPerio9 in Amsterdam, June 2018, a new classification of periodontal and peri-implant diseases has been introduced to the global dental community. The result of a joint workshop held by the European Federation of Periodontology and the American Academy of Periodontology, the new system provides clarity on the different severity levels of the condition. 

Mirroring the classification system used throughout the medical industry that defines the stage of a condition and its risk of progression, this method of categorising periodontal disease is designed to standardise treatment approaches throughout the global dental profession. It describes periodontitis in four stages of severity – Stage 1 (least severe) to Stage 4 (most severe) – and three grades determining the risk of development – Grade A (lowest risk) to Grade C (highest risk). In this way, it provides a universal language that can be easily translated not only across geographic borders, but also between professionals in dental and medical fields for more seamlessly integrated patient care pathways.

At the time of writing, the new system is in the process of being rolled out across the UK dental profession and the British Society of Periodontology (BSP) has announced its aim to consider the consensus carefully before reviewing its own guidance in the near future. How this new classification system will affect your daily practice life is yet to be determined, but you can expect changes on the horizon, if they haven’t already been implemented. 

A holistic approach

However you evaluate and classify periodontal disease, the most important thing remains that you assess it regularly and record it for every patient under your care. The associations between periodontitis and many systemic diseases demonstrate a clear need for prevention and early identification in order to help patients maintain good general, as well as dental health.

Diabetes mellitus is the example often cited given that research has found a bi-directional relationship between the condition and periodontitis. Those with poor glycaemic control are at high risk of developing periodontal disease, while treatment of periodontal inflammation is believed to improve glycaemic control.[i]

Other health conditions linked with periodontitis include cardiovascular disease (CVD) – studies have suggested up to a 90% increase in risk for CVD among those with severe periodontal disease, possibly due to mutual risk factors.[ii]Periodontitis is also associated with pneumonia – although a causal relationship is not yet established[iii]– while a stronger case can be put together to support the link between periodontal disease and rheumatoid arthritis.[iv]

When it comes to cancer, various different types have been associated with poor periodontal health. For example, a 2017 study found that women with periodontitis had a two-three times higher risk of developing breast cancer than those without.[v]Another study found associations between a history of periodontal disease and lung, kidney and pancreatic cancer among men in the US.[vi]As would be expected, a significant correlation between periodontal disease and oral cancer has also been proven.[vii]

Preventing periodontal disease can therefore have a huge influence over one’s general wellbeing. As such, the merits of taking a holistic approach to managing a patient’s periodontal health cannot be overstated. The new periodontal classification system may well aid in doing this as it bridges the gap between medical and dental professionals and facilitates easier communication and collaboration for improved patient care. 

Start with the basics

Of course, the prevention and management of periodontitis starts with an effective oral care routine at home. Patients should be educated on the potential connections between gingival disease and systemic health conditions, so that they understand the risks they take by not adequately brushing or cleaning interdentally. 

Regular appointments at appropriate recall intervals are essential, during which times the patient’s oral health can be reviewed. Development or progression of any periodontal disease should be accurately assessed and recorded every time. Evidence-based products and techniques should also be suggested to help support daily regimes. For example, the Wisdom Clean Between Rubber Interdental Brushes are clinically proven to reduce gingival disease[viii],[ix]and feature a tapered, flexible stem with micro-fine rubber filaments that glide easily between the teeth for a gentle but effective clean. An ideal introduction to interdental cleaning, they are easy to use and suitable for continued everyday use. Being wire-free they are gentle on the gingiva minimising the potential for gum trauma and ideal for efficient and are safe use around orthodontic appliances, implants, metal fillings and crowns. Available in three sizes and latex-free, they are suited to a wide range of patients, including those who have found using wire interdental brushes difficult or uncomfortable in the past. 

Effective management of periodontal disease – or better still prevention – remains an essential part of every dental professional’s remit. A multidisciplinary approach that involves both dental and medical professionals offers various benefits for the quality of patient care, so utilising tools such as the new classification system may well help make this a reality in everyday practice.

To find out more, please visit www.wisdomtoothbrushes.comor 

call 01440 714800

[i]Preshaw PM, Alba AL, Herrera D, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2011;55(1):21-31.

[ii]Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94(1):10-21.

[iii]Paju S, Scannapieco FA. Oral biofilms, periodontitis, and pulmonary infections. Oral Dis. 2007;13(6):508-12.

[iv]Bingham CO, Moni M. Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Curr Opin Rheumatol. 2013;25(3):345-53.

[v]Sfreddo CS, Maier J, De David SC, Susin C, Moreira CHC. Periodontitis and breast cancer: A case-control study. Community Dent Oral Epidemiology. 2017;45:545-551.

[vi]Michaud DS. Liu Y, Meyer M, Giovannucci E, Joshipura K. Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. The Lancet Oncology. June 2008; 9(6):550-558

[vii]Ye L, Jiang Y, Liu W, Tao H. Correlation between periodontal disease and oral cancer risk: A meta-analysis. J Can Res Ther 2016;12:237-40

[viii]Yost et el, Interproximal gingivitis and plaque reduction by four interdental products. J Clin Dent. 2006;17(3):79-83.

[ix]Prof. Dr. Petra Ratka-Krüger et al, Clinical trial of a metal-free interdental brush. University Medical Centre Freiburg, Germany. Pub Nov 2010.

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